CAJ | 학술논문

目的探讨癫痫发作期SPECT脑血流灌注显像和视频脑电图(VEEG)在致痫灶定位中的一致性.方法选择VEEG监测异常的癫痫患者45例,当患者出现临床发作和(或)脑电图出现典型癫痫波时30 s内注入锝-双半胱乙酯(99Tcm-ECD),30 min后行脑血流灌注断层显像.比较癫痫发作期SPECT脑血流灌注显像和VEEG在癫痫定位诊断中的一致性,对部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性进行卡方检验.结果 45例癫痫患者中,发作期SPECT定位阳性率为93.3％(42/45),均表现为高血流灌注灶,其中40例(95.2％)表现为单叶局限性高灌注,2例(4.8％)表现为多个病灶高灌注.VEEG监测结果为:31例患者VEEG表现为局灶性异常放电,明确定位达68.9％(31/45),各导联同步对称性异常放电不能定位者占所有患者的31.1％(14/45).比较二者定位结果发现,对于部分性发作的患者,发作期SPECT和VEEG定位的一致性为83.9％(26/31);对于全面性-强直阵挛发作的患者,VEEG表现为各导联同步对称性异常放电,而发作期SPECT则显示为孤立高血流灌注灶,故二者定位无一致性.部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性差异有统计学意义(x2=24.478,P＜0.05).结论发作期SPECT脑血流灌注显像和VEEG在癫痫灶定位诊断中的一致性与癫痫发作类型相关.对于部分性发作的癫痫患者二者联合定位可指导手术治疗;而对于全面性-强直阵挛发作患者,发作期SPECT脑血流灌注显像和VEEG联合定位无一致性,需借助于其他检查方法方可明确定位.
목적 탐토전간발작기SPECT뇌혈류관주현상화시빈뇌전도(VEEG)재치간조정위중적일치성.방법 선택VEEG감측이상적전간환자45례,당환자출현림상발작화(혹)뇌전도출현전형전간파시30 s내주입득-쌍반광을지(99Tcm-ECD),30 min후행뇌혈류관주단층현상.비교전간발작기SPECT뇌혈류관주현상화VEEG재전간정위진단중적일치성,대부분성발작화전면성-강직진련발작환자발작기SPECT화VEEG정위적일치성진행잡방검험.결과 45례전간환자중,발작기SPECT정위양성솔위93.3％(42/45),균표현위고혈류관주조,기중40례(95.2％)표현위단협국한성고관주,2례(4.8％)표현위다개병조고관주.VEEG감측결과위:31례환자VEEG표현위국조성이상방전,명학정위체68.9％(31/45),각도련동보대칭성이상방전불능정위자점소유환자적31.1％(14/45).비교이자정위결과발현,대우부분성발작적환자,발작기SPECT화VEEG정위적일치성위83.9％(26/31);대우전면성-강직진련발작적환자,VEEG표현위각도련동보대칭성이상방전,이발작기SPECT칙현시위고립고혈류관주조,고이자정위무일치성.부분성발작화전면성-강직진련발작환자발작기SPECT화VEEG정위적일치성차이유통계학의의(x2=24.478,P＜0.05).결론 발작기SPECT뇌혈류관주현상화VEEG재전간조정위진단중적일치성여전간발작류형상관.대우부분성발작적전간환자이자연합정위가지도수술치료;이대우전면성-강직진련발작환자,발작기SPECT뇌혈류관주현상화VEEG연합정위무일치성,수차조우기타검사방법방가명학정위.
Objective To localize the epileptic focus by means of ictal SPECT and video-electroencephalography(VEEG) patterns to decide whether the combination of them are capable of localizing epileptic focus correctly.Methods The present study was performed in 45 epileptic patients,who showed spike waves during VEEG monitoring when deprived of sleep to provoke seizures,even oral application of clonidine was given when deprivation of sleep was failed in limited time.Technetium-99m ethyl cysteinate dimer(99Tcm-ECD)was injected within 30 s when a clinical sign and/or an typical VEEG discharge was recognized,then brain SPECT was performed after 30 min.In the end,compared the results of ictal SPECT and VEEG in localization.x2 test was performed by using software SPSS l 9.0.Results Ictal brain SPECT localized in 93.3％ (42/45)patients,of whom 95.2％ (40/42)patients had single hyperperfusion,and 4.8％(2/42)had multiple hyperperfusion.VEEG showed partial seizures in 68.9％ (31/45) patients,and 31.1％(14/45)patients showed generalized spike waves.The relationship of ictal SPECT and VEEG in localizing epileptic focus was turned out as following:Firstly,the consistency of ictal SPECT and VEEG is 83.9％(26/31)in partial seizure,as for generalized tonic-clonic seizure,VEEG showed generalized spike waves,and ictal brain SPECT declared single hyperperfusion,therefore,the localization of them was different.The consistency of partial seizure was significantly higher than that of generalized tonic-clonic seizure (x2=24.478,P＜0.05).Conclusions The consistency of ictal SPECT and VEEG in localization has something to do with epilepsy categories.The study indicates that it is possible to obtain localization in patients with partial seizures using a combination of ictal SPECT and VEEG patterns,as for generalized tonic-clonic seizure,the combination of them is not enough and it' s imperative to use other techniques.