难治性局灶性癫痫的多学科团队模式诊疗策略

目的:探讨难治性局灶性癫痫的多学科团队模式(multidisciplinary team, MDT)诊疗策略。方法:介绍1例药物难治性颞叶癫痫,头皮脑电图监测示患者双侧颞区不同步放电,常规磁共振序列扫描未见明显异常,初步评估为患者病灶位置和侧向性不明。进行MDT讨论和后续进一步术前评估,明确患者致痫灶和治疗方法。结果:患者为右内侧颞叶癫痫,接受右侧前颞叶+海马+杏仁核切除术,术后病理示致痫灶为节细胞胶质瘤合并局灶性皮质发育不良(局灶性皮质发育不良Ⅲb型)。术后1年余患者无癫痫发作。结论:MDT模式有助于进一步明确难治性局灶性癫痫患者的致痫灶部位,为患者的进一步手术治疗提供精准定位和手术切除范围参考,促使患者术后达到无发作状态。

Diagnosis and treatment strategy for refractory focal epilepsy in multidisciplinary model

Objective: To describe the multidisciplinary team (MDT) diagnosis and treatment for one case of refractory focal epilepsy patient, in order to explore the diagnosis and treatment strategies for refractory focal epilepsy patients. Methods: The patient was diagnosed as intractable temporal lobe epilepsy. The interictal scalp electroencephalogram showed unsynchronized epileptiform discharges on bilateral temporal lobes. The conventional magnetic resonance imaging was normal with no obvious lesions. Finally, the epileptogenic focus was discovered as the right hippocampus after MDT diagnosis and presurgical evaluation. Then the patient was planned to undergo surgical treatment. Results: The patient was diagnosed as right medial temporal lobe epilepsy after detailed preoperative assessment, and was further operated with the resection of anterior temporal lobe, hippocampus and amygdaloid nucleus. The postoperative pathology revealed focal cortical dysplasia type IIIb of the ganglioglioma with the focal cortical dysplasia in surrounding tissues. Conclusions: The case exhibited the superiority of the MDT system in the diagnosis of the epileptogenic focus in refractory focal epilepsy patient. The MDT system helped to precisely localize the epileptogenic focus and provided foundation for the surgical resection range. The MDT diagnosis and treatment helped the patient to reach postoperatively seizure-free and come back into society.