视频脑电监测下注射贝美格定位致痫灶的研究

目的：对连续24h监测无发作的顽固性癫痫患者进行贝美格静脉注射诱发痫性发作．辅助定位致痴灶。方法：在视频头皮或深部电极脑电图描记监测下，对需手术治疗的25例顽固性癫痼患者，以25mg/min的速度静脉匀违注射贝美格。最大剂量为150mg，对有发作的患者根据症状学和脑电图发作波形确定致痫灶。结果：30例患者中出现临床发作25例（83％），其中21例（84％）能通过脑电图大致判定致痫灶，与日常发作组对比差异无统计学意义（P〉0．05），2例（8％）能大致判断癫痫起源侧别，1例无法判定致痫灶，1例（4％）出现新症状，其深部电极脑电图显示贝美格诱发的致痫灶与自然发作脑电起源不符。临床发作者注射贝美格剂量为（108．0±30．8）mg，发作后均静脉沣射0．2g苯巴比妥，发作停止时间为（3．0±1．0）min，发作前未见诱发出新位置的痢样放电。结论：贝美格诱发试验在诱发痫性发作对致痫灶定位有辅助作用，其原理可能与其使致痫灶的痫样放电被激活或使之更加活跃有关。

Epileptogenic zones located by intravenous injection bemegride during video-EEG monitoring

Objective：To locate the epileptogenic zones of the patients with intractable epilepsy who had no seizure during video-EEO monitoring within 24 hours by intravenous injection bemegride. Methods ： During scalp or depth electrodes video EEG monitoring, bemegrlde（25mg/min, ≤ 150 mg） was injected to the 30 patients with intractable epilepsy. The onset zones were located by the epileptic discharges and symptoms at the seizure onset. Results： 25 （83 %） patients had seizures with intravenous injection bemegride,and the onset zones with no difference from habitual seizures（P〉0.05）in 21 （84 %） could be lo cated. 1 case（4% ）, whose intravenous injection bemegride was on the reverse side of the usual seizure had new symptom. The dosage to induce seizure was 108.0±30.8 mg,and by intravenous injection phenobarbital（0.2 g） ,the seizures ended in 3.0±1.0 min. No new epileptic irritative zone was found by intravenous injection bemegride. Conclusion： Our data suggest that the epileptic discharges and symptoms by in travenous injection bemegride at the seizure onset contribule to the location of the epileptogenic zone.