中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2013年
8期
825-828
,共4页
任思颖%伍国锋%秦冠南%毛远红
任思穎%伍國鋒%秦冠南%毛遠紅
임사영%오국봉%진관남%모원홍
颞叶内侧癫痫%海马%深部电极%立体定向技术%视频脑电图%海马脑电图
顳葉內側癲癇%海馬%深部電極%立體定嚮技術%視頻腦電圖%海馬腦電圖
섭협내측전간%해마%심부전겁%입체정향기술%시빈뇌전도%해마뇌전도
Mesial temporal lobe epilepsy%Hippocampus%Depth electrode%Stereotactic technique%Video-EEG%Hippocampal EEG
目的 观察耐药性颞叶内侧癫痫患者发作前期海马电极脑电活动特点,为判断和切除癫痫病灶提供神经电生理学依据.方法 对16例非侵入性手段难以明确病灶的耐药性颞叶内侧癫痫患者进行双侧海马电极监测,患者停用抗癫痫药在非麻醉状态下监测48～72 h,分析癫痫发作前期海马电极脑电图资料,探讨耐药性颞叶内侧癫痫发作前期海马电极脑电活动特点.结果 16例发作间期记录到背景活动基础上出现局限于某几个电极点的阵发性高幅慢波1例、发作性快波节律1例、棘波或棘尖慢复合波14例,视为异常脑电活动；经过48～ 72 h监测,10例监测到33次临床癫痫发作,发作起始期海马电极均可记录到清晰可辨的癫痫样脑电波形.结论 颞叶内侧癫痫临床发作起始期海马电极癫痫样放电清晰可辨,部位局限,易于确定癫痫性活动起源部位.对于非侵入性手段难以判断癫痫样放电起源的颞叶内侧癫痫可采用脑立体定向技术植入海马深部电极进行脑电监测.
目的 觀察耐藥性顳葉內側癲癇患者髮作前期海馬電極腦電活動特點,為判斷和切除癲癇病竈提供神經電生理學依據.方法 對16例非侵入性手段難以明確病竈的耐藥性顳葉內側癲癇患者進行雙側海馬電極鑑測,患者停用抗癲癇藥在非痳醉狀態下鑑測48～72 h,分析癲癇髮作前期海馬電極腦電圖資料,探討耐藥性顳葉內側癲癇髮作前期海馬電極腦電活動特點.結果 16例髮作間期記錄到揹景活動基礎上齣現跼限于某幾箇電極點的陣髮性高幅慢波1例、髮作性快波節律1例、棘波或棘尖慢複閤波14例,視為異常腦電活動；經過48～ 72 h鑑測,10例鑑測到33次臨床癲癇髮作,髮作起始期海馬電極均可記錄到清晰可辨的癲癇樣腦電波形.結論 顳葉內側癲癇臨床髮作起始期海馬電極癲癇樣放電清晰可辨,部位跼限,易于確定癲癇性活動起源部位.對于非侵入性手段難以判斷癲癇樣放電起源的顳葉內側癲癇可採用腦立體定嚮技術植入海馬深部電極進行腦電鑑測.
목적 관찰내약성섭협내측전간환자발작전기해마전겁뇌전활동특점,위판단화절제전간병조제공신경전생이학의거.방법 대16례비침입성수단난이명학병조적내약성섭협내측전간환자진행쌍측해마전겁감측,환자정용항전간약재비마취상태하감측48～72 h,분석전간발작전기해마전겁뇌전도자료,탐토내약성섭협내측전간발작전기해마전겁뇌전활동특점.결과 16례발작간기기록도배경활동기출상출현국한우모궤개전겁점적진발성고폭만파1례、발작성쾌파절률1례、극파혹극첨만복합파14례,시위이상뇌전활동；경과48～ 72 h감측,10례감측도33차림상전간발작,발작기시기해마전겁균가기록도청석가변적전간양뇌전파형.결론 섭협내측전간림상발작기시기해마전겁전간양방전청석가변,부위국한,역우학정전간성활동기원부위.대우비침입성수단난이판단전간양방전기원적섭협내측전간가채용뇌입체정향기술식입해마심부전겁진행뇌전감측.
Objective To observe the characteristics of preictal hippocampal depth electrode EEG in patients with pharmacoresistant mesial temporal lobe epilepsy,and to accumulate experiences for judgement of epiletic focus and to provide neuroelectrophysiological evidences for surgical resection of epileptic focus.Methods Depth electrode was implanted into bilateral hippocampus of patients with pharmacoresistant mesial temporal lobe epilepsy.Hippocampal depth electrode EEG monitoring lasted for 48 ～72 hours with the patients' AED discontinued,and then the preictal hippocampal EEG data of the 16 patients were analyzed to observe the features of the epileptiform discharges recorded by hippocampal depth electrode.Results 16 patients experienced monitoring for 48 ～72 hours,33 epileptic seizures in 10 patients were detected.The interictal waveform of EEG from each electrode contact was similar to others,Paroxysmal high amplitude and slow wave in 1 patient,paroxysmal fast frequency in 1 patient and spike and slow wave complex in 14 patients on the background were considered to be abnormal electrical activity.Legible EEG waveform was recorded by hippocampal electrode in16 patients during epileptic seizures.The onset of epileptiform discharges manifested with locally original electrical activity with high amplitude and fast frequency in 1 patient(16 Hz) and slow waveform rhythm in 1 patient and continuous sharp rhythm in 10 patients and slow wave complex or spike and slow wave complex in 4 patient on basic background activity.The epileptogenic focus is located in the left anterior prehippocampus in 8 patients and in the right anterior prehippocampus in 4 patients and in bilateral hippocampal in 4 patients.Conclusions Hippocampal electrode EEG waveform in patients with pharmacoresistant mesial temporal lobe epilepsy was legible.The epileptiform discharges were limited to some electrode contacts.So the epileptogenic zone could be easily determined.If epileptogenic focus could not be determined by scalp EEG or other noninvasive procedures in patients with pharmacoresistant mesial temporal lobe epilepsy,stereotactic implantation of depth electrode into the hippocampus for EEG monitoring might be required.
