外科手术治疗中枢神经系统感染后继发难治性癫痫的预后分析

目的:分析中枢神经系统感染后继发难治性癫痫患者的临床特点以及影响外科手术治疗的预后因素。方法:2006年5月至2008年8月就诊于北京功能神经外科研究所继发于中枢神经系统感染后的难治性癫痫患者共29例。所有患者均接受CT或MRI以及脑电图检查,其中接受分期颅内皮层电极及癫痫病灶切除术患者11例。为13例(44.8%)患者施行了标准前颞叶切除术,16例(55.2%)接受了颞叶外大脑皮层切除术。结果:18例(62.1%)手术治疗后效果良好,包括80%的颞叶癫痫与50%的颞叶外癫痫。结论:中枢神经系统感染的病史并不能成为此类难治性癫痫患者手术治疗的禁忌证,关键在于是否能确定致痫灶的位置,此外,患者感染的年龄以及感染后至首次癫痫发作潜伏期的时间长短为对预后有明显影响的因素。分期颅内皮层电极埋置能显著增加致痫灶的检出率,但并没有改善病灶切除的预后。

Prognostic analysis of surgical treatment on intractable epilepsy after central nervous system infections

Objective To analyze the clinical features refractory epilepsy after central nervous system(CNS) infection and prognostic factors affecting surgical treatment.Methods 29 patients with intractable epilepsy after CNS infections were selected from Beijing Institute of Functional Neurosurgery from May 2006 to August 2008.All patients underwent CT or MRI,and electroencephalogram examinations,including 11 patients accepted cortical electrodes by stages and resection of epileptic foci.13(44.8%) patients underwent anterior temporal lobectomy,and 16(55.2%) underwent resectoion of extratemporal pallium corticectomy.Results 18(62.1%) patients obtained good results after surgical treatment,including 80% with temporal lobe epilepsy and 50% with extratemporal epilepsy.Conclusions CNS infection was not a contraindication for surgical treatment in cases with intractable epilepsy and identification of epileptic foci was crucial.In addition,the age of infection,as well as the length ranging from infection to suffering the first epilepsy seizure was two factors for prognosis.Cortical electrodes had significantly increased the detection rate of epileptic foci,but couldn’t improve prognosis of foci excision.