颅内电极监测对顽固性颞叶癫痫致痫灶的定位价值

目的:探讨发作期及发作间期颅内电极监测对癫痫灶的定位作用。方法:20例难治性颞叶癫痫,经临床、影像学及头皮脑电图不能确定致痫灶部位,应用立体定向技术,在患者双侧颞叶植入硬膜下条状电极,进行长时间视频脑电图监测,记录发作期和发作间期的脑电图变化,并与头皮脑电图、MRI进行比较,分析癫痫灶部位,进行手术治疗,术后跟踪随访,评估致痫灶定位的准确性。结果:20例癫痫病人颅内电极埋藏时间1～5天,每个患者至少监测到2次临床发作,每一病例均记录发作间期和发作期的异常放电活动。15例发作间期与发作期定侧一致,2例发作间期为双侧棘波病灶,3例发作间期定位与发作期不一致。按Engel术后效果分级:手术效果满意(癫痫发作消失)13例(65%),显著改善3例(15%),良好3例(15%),无效1例(5%)。所有病例均未出现因颅内电极埋藏而致的并发症。结论:对于致痫灶不能定位的难治性癫痫,应用颅内电极记录方法,尤其是发作期起始时脑电图变化,可以确定致痫灶位置,为癫痫手术治疗提供可靠的依据。

Value of intracranial EEG recording for localizing epileptogenic zone in refractory temporal lobe epilepsy

Objective: To explore the role of long-term intracranial EEG recording in patient with refractory temporal lobe epilepsy for localizing epileptogenic zone. Methods: twenty refractory temporal lobe epilepsy, whose seizure onsets were unable to be localized with MRI,scalp EEG recording and clinical characteristic, Accepted long-term intracranial EEG monitoring to record the ictal and interictal EEG monitoring under the guiding of the stereotactic technique, The results from routine EEG and cortical electrode EEG were compared. The accuracy for localization of epilepitogenic zone was evaluated based on the clinical follow-up. Results: The intracraniai electrode EEG monitoring was implanted within 1~5days. Each patient was recorded the ictal and interictal discharge and was detected clinical onsets at least two times. All patients can be localized by ictal EEG. The consistency between interical EEG and ictal EEG was seen in 15 cases, and the inconsistency was in 3 cases, and 2 cases were bilateral discharge in interictal. The clinical outcome showed that patients were seizure-free in 13 cases (65%), improved significantly in 3 cases (15%), improved in 3 cases (15%), unimproved in 1 case (5%) according to Engel's criteria after surgery. For all patients, no significant complication was found. Conclusions: lntracranial EEG recording, especially ictal recording in the initial stage of seizure is effective for precise epileptogenic zone localization in patients with refractory epilepsy and can offer reliable evidence for surgery.