顽固性癫痫的电镜病理与临床研究

目的：研究顽固性癫痫（IEP）的电镜病理特征，分析其与临床的关系及可能的致病机理，并证实EP发作对大脑的损害。方法：对2例病人经手术切除之颞叶皮层及额叶皮层活检组织进行透射电镜观察，并对患的影像学、脑电图（EEG）、皮层电极EEG的结果及手术方法、术中所见进行记录，并随访疗效。结果：电镜病理所见：神经元及胶质细胞存在变性、调亡，神经元细胞内易见脂褐素颗粒。细胞器结构异常。有髓纤维增生紊乱、髓鞘崩解退变广泛存在，见有髓纤维发芽状态及髓鞘样小体。上述神经变性改变颞叶重于额叶，而额叶以纤维增生紊乱为主。临床上：IEP的头MR常见海马萎缩，术中可见脑萎缩，皮层电极EEG显萎缩明显处EP波相应减少，手术应以皮层电极EEG为指导，手术疗效确切。结论：1.反复EP发作导致大脑继发性永久损害。2.影像学显海马硬化时，推测脑的继发性损害严重，电镜上为神经元及胶质细胞变性调亡、纤维增生和髓鞘破坏，术中可见脑萎缩，EEG上颞叶EP样放电相应减少。3.在EP样放电活跃的额叶皮层，神经变性较轻，但存在神经纤维增生紊乱，髓鞘破坏已普遍存在，存在异常神经网络，推测其为IEP的病理基础。4.IEP的手术治疗是可取并有效的，有客观的病理根据。

Study of Electromicroscopic Pathology and Clinical Characteristics of Intractable Epilepsy

Objective:To study the characteristics of electromicroscopic pathology of intractable epiltoepsy and to analyze the relationship between it and the clinical characteristics and pathogenesis. Methods:Tissues of temporal lobe and forntal lobe from two cases of intractable epilepsy were examined under the electromicroscope. The results of imaging,EEG and cortical electrode EEG,the operation type and the findings during operation were recorded,and the effects of operation was followed up. Results: The electromicroscopic examination showed degeneration and apoptosis in neurons and neurogliocytes. The neurodegenerative changes were more severe in temporal lobes than in frontal lobes,while disorderly fibrohyperplasia was mainly found in frontal lobe.MR showed hippocampus atrophy .The cerebral atrophy was observed during the operation. Conclusios:1.recurrent epileptic ictus lead to secondary permanent lesion in brain. 2.Hippocampus sclerosis shown on neuroimaging impliates severe secondary lesion of the brain. 3.On the frontal lobe with active ictal epileptic discharges,the neurodegeneration is mild. 4.The surgical treatment of intractable epilepsy is preferable and effective.