CAJ | 학술논문

目的总结起始于额下回及额盖的癫痫发作的电-临床特点.方法回顾性分析2011年至2014年在清华大学玉泉医院行癫痫术前评估并经颅内电极脑电图证实起始于额下回及额盖的7例难治性癫痫的临床资料,包括症状学表现、头皮及颅内脑电图、影像学、手术情况及初步随访结果.结果所有患者都有先兆,其中5例均为非特异性先兆.7例患者中6例均出现过度运动发作,4例患者出现面部改变,表现为面部对称或不对称性强直,形成咧嘴动作.仅有1例患者出现自主神经症状.4例患者MRI均显示有病灶,并提示为局灶性皮质发育不良(FCD),其余3例患者的MRI阴性.5例术前完成了氟代脱氧葡萄糖(FDG)-PET检查.3例MRI阴性的病例中,其PET均提示有代谢减低区.5例头皮脑电图记录到间歇期癫痫样放电,均有侧向性意义,主要分布于前头部,包括额、颞区、中央区等.发作期脑电图定位意义较差.所有患者均进行了手术切除,3例患者位于左侧优势半球,其中2例分别出现经皮质运动性失语和命名性失语,术后随访均有所恢复.术后病理显示均为FCD,6例为FCDⅡ型.术后发作的初步随访取得较好效果.结论额下回及额盖癫痫发作以非特异性先兆,伴有面部对称或不对称性强直(咧嘴)的过度运动发作为特点,自主神经症状并不多见.间歇期脑电图有侧向性意义,但可累及前头部广泛区域,发作期脑电图定侧及定位意义较差.在颅内电极脑电图指导下的局灶性皮质切除可取得较好手术效果.
목적 총결기시우액하회급액개적전간발작적전-림상특점.방법 회고성분석2011년지2014년재청화대학옥천의원행전간술전평고병경로내전겁뇌전도증실기시우액하회급액개적7례난치성전간적림상자료,포괄증상학표현、두피급로내뇌전도、영상학、수술정황급초보수방결과.결과 소유환자도유선조,기중5례균위비특이성선조.7례환자중6례균출현과도운동발작,4례환자출현면부개변,표현위면부대칭혹불대칭성강직,형성렬취동작.부유1례환자출현자주신경증상.4례환자MRI균현시유병조,병제시위국조성피질발육불량(FCD),기여3례환자적MRI음성.5례술전완성료불대탈양포도당(FDG)-PET검사.3례MRI음성적병례중,기PET균제시유대사감저구.5례두피뇌전도기록도간헐기전간양방전,균유측향성의의,주요분포우전두부,포괄액、섭구、중앙구등.발작기뇌전도정위의의교차.소유환자균진행료수술절제,3례환자위우좌측우세반구,기중2례분별출현경피질운동성실어화명명성실어,술후수방균유소회복.술후병리현시균위FCD,6례위FCDⅡ형.술후발작적초보수방취득교호효과.결론 액하회급액개전간발작이비특이성선조,반유면부대칭혹불대칭성강직(렬취)적과도운동발작위특점,자주신경증상병불다견.간헐기뇌전도유측향성의의,단가루급전두부엄범구역,발작기뇌전도정측급정위의의교차.재로내전겁뇌전도지도하적국조성피질절제가취득교호수술효과.
Objective To summarize the clinical features of inferior frontal gyrus and frontal opercular seizures.Methods The clinical presurgical evaluation data of seven patients whose seizures onset zone involved inferior frontal gyrus and frontal opercular were analyzed retrospectively.The data included seizure semiology,scalp and intracerebral video-electroencephalography (EEG),imaging,surgery and follow up results.Results All the patients reported auras,but 5 were non specific auras.Six patients manifested hypermotor seizure and facial changes that were facial muscle tonic or asymmetric tonic (rictus)were found in 4 patients.Four patients' MRI showed lesions which indicated focal cortical dysplasia (FCD).PET images showed hypometabolic changes in the other 3 MRI negative patients.Scalp EEG showed anterior head interictal discharges and lateralization in 5 patients,while ictal EEG showed no lateralization.All the patients underwent a tailored resections.Two patients manifested transcortical motor aphasia and anomic aphasia,which improved 40 or 50 days post-operation.Histology revealed FCD type Ⅱ in six patients.The preliminary results of seizure follow up were favorable.Conclusions Inferior frontal gyrus and frontal opercular seizures are characterized by non specific auras,facial tonic or asymmetric tonic (rictus) and hypermotor.Autonomic seizures are rare.Scalp EEG shows lateralization,while ictal EEG shows no lateralization.The tailored resections guided by intracerebral EEG has a good outcome.