外伤性癫痫79例临床分析

目的探讨外伤性癫痫的危险因素、临床特征及防治措施。方法79例外伤性癫痫患者均常规给予抗癫痫药物治疗，其中35例难治性癫痫患者接受手术治疗，术中行皮质脑电图监测。术式包括致痫灶切除、前颞叶切除、选择性杏仁核-海马切除、胼胝体前部切开、多处软膜下横纤维切断术等。结果随访6—48个月，44例保守治疗者中，18例在癫痫控制2年后逐步减量停药，未见发作；其余患者仍继续口服药物治疗，2例仍时有发作。35例手术患者，按照Engel分级，I级18例，Ⅱ级12例，Ⅲ级5例，无Ⅳ级患者，有效率85．7％（30／35）。结论消除外伤性癫痫的危险因素以降低其发生率、正规抗癫痫药物治疗、选择合适的患者手术治疗是获得外伤性癫痫理想治疗效果的重要措施。

Clinical analysis of 79 cases of posttraumatic epilepsy

Objective To explore the risk factors, clinical characteristics, prevention and treatment of posttraumatic epilepsy. Methods All the 79 patients received conventional antiepileptic drugs treatment, among which 35 patients with intractable posttraumatic epilepsy underwent surgical treatment under intro-operative electrocorticogram monitoring. The surgery included resection of the epileptogenic focus, anterior temporal lobectomy, selective amygdalo-hippocampectomy, anterior corpus callosotomy and multiple subpial transaction, as indicated in different cases. Results All the patients were followed up from 6 to 48 months after the treatment. Among 44 patients with only conservative therapy, 18 cases dropped out of medication with no recurrence, and the others con- tinued the medication with 2 cases still having epileptic attacks. Of the 35 cases operated, 18 cases were Engel grade Ⅰ , 12 cases grade Ⅱ , 5 cases grade Ⅲ, and no cases grade Ⅳ, with the effective rate being 85.7% （30/35）. Conclusions The satisfactory treatment outcome of posttraumatic epilepsy can be obtained by reducing the risk factors, standard antiepilepsy medication, and epilepsy surgery in selected cases.