脑电定位与手术治疗难治性癫痫疗效观察

目的 探讨难治性癫痫的术前、术中脑电图定位方法及手术疗效.方法 对621例难治性癫痫患者采用普通脑电图监测(REEG)、长程脑电图监测(AEEG)、视频脑电图监测(VEEG),结合患者病史特点及影像学结果进行综合定位;术中在皮层脑电图(ECoG)监测下依据脑电图定位及不同发作类型选择适合术式切除致痫灶,并观察术后疗效.结果 术后随访6月至4年,满意(术后无发作)340例,占55%;显著改善(发作减少＞75%)223例,占36%;良好(发作减少50%～75%)37例,占6%;效差(发作减少＜50%)21例,占3%;无加重病例;有效率达97%.结论 以脑电图监测为基本手段,采用综合定位的方法结合术中ECoG监测明确癫痫灶的部位和范围以指导手术,能有效防止并发症的发生,并取得良好的治疗效果.

Curative effect of EEG localization and microsurgery for intractable epilepsy

Objective To explore the epileptogenic focus locating methods before and during operation and the curative effect of surgical treatment on the basis of localization. Methods Epileptogenic foci in 621 cases of intractable epilepsy were localized according to clinical manifestations and imaging findings by routine EEG (REEG), ambulatory EEG (AEEG) or video-EEG (VEEG).Different types of operations were performed based on the categories of epilepsy, the preoperatively localized foci and electrocorticogram (ECoG) monitoring results during operations. Results The follow-up ranging 0.5-4 years revealed, according to the criteria of International Antiepileptic Association,that 340 cases(54%)were completely recovered(no postoperative seizure),223 cases(36%)were improved obviously (seizure frequency was decreased by more than 75%), 37 cases (6%) were improved a little(seizure frequency was decreased by 50%-75%)and 21(3%)were not improved(seizure frequency was decreased by less than 50%): the effective rdte was 97%.No case worsened.Conclusions Preoperative integrated localization by EEG principally and intraoperative ECoG monitoring can effectively confirm the site and size of epileptogenic foci to instruct the operation and prevent complications so that the satisfactory treatment efficacy can be achieved.