术前头皮长程视频脑电图表现与颞叶癫痫手术预后的关系

目的探讨术前头皮长程视频脑电图(VEEG)发作间期放电、发作期起始侧别与颞叶癫痫(TLE)患者手术预后的关系。方法回顾性分析75例颞叶癫痫手术治疗患者的临床资料。患者术后经过1~9年的随访,根据手术后有、无癫痫发作将患者分为发作组和无发作组。另外按两组患者中术前头皮脑电图发作间期放电及发作期起始侧别分组,比较各组患者中发作组与无发作组患者的比率。结果75例患者中术后有发作者34例(发作组),无发作者41例(无发作组)。术前头皮VEEG发作期起始单侧且发作间期同侧放电者24例,其中发作组4例、无发作组20例,差异有统计学意义(P<0.01)。手术侧别与影像证据同侧的72例患者中,发作组34例,无发作组38例;脑电图(发作期与发作间期)与影像证据一致患者中,发作组4例,未发作组20例,差异有统计学意义(P<0.01)。症状学与影像学表现一致的49例患者中,发作组22例,无发作组27例;与发作期及发作间期脑电均一致患者中,发作组3例,无发作组17例,差异有统计学意义(P<0.05)。结论术前VEEG发作期起始为单侧且与发作间期放电同侧、手术侧别与影像学异常同侧且VEEG(发作期与发作间期)与影像学异常一致,以及术前影像学、症状学和VEEG表现三者一致的颞叶癫痫患者手术治疗的预后较好。

Correlation between preoperative scalp long range video electroencephalography and postoperative outcomes of temporal lobe epilepsy

Objective To investigate the influence of long-term video electroencephalogram(VEEG)on the prognosis of patients with temporal lobe epilepsy(TLE).Methods 75 patients with TLE were retrospectively analyzed.After 1-9 years of follow-up,according to the seizure onset after operation,the patients were divided into seizure group and seizure free group.The patients were divided into two groups according to the interval discharge of scalp EEG before operation and the onset of attack.Results Of the 75 patients,there were 34 patients with seizures and 41 patients without seizures.Among all the selected cases,there were 24 cases with unilateral discharge at the onset of attack and ipsilateral discharge at intermission,4 cases in attack group and 20 cases in non attack group,with significant difference between groups(P<0.01).There were 34 cases in the attack group and 38 cases in the non attack group.There were 4 cases in the attack group and 20 cases in the non attack group when the EEG(attack period and intermission period)was consistent with the image evidence(P<0.01).There were 49 cases with the same results of symptomatology and imaging,22 cases with seizure and 27 cases without seizure after operation.There were 3 cases with seizure and 17 cases without seizure in the postoperative seizure group with the same results of seizure and intermittent EEG,and the difference between the two groups was significant(P<0.05).Conclusion The prognosis of patients with TLE is better when the onset of video EEG before operation is unilateral and the discharge of intermission is on the same side.The prognosis of patients with TLE is better when the EEG(seizure and intermission)is consistent with the image evidence.The prognosis of patients with temporal lobe epilepsy is better when the evidence of imaging,symptoms and EEG is consistent.