摘要
目的探讨皮层脑电图监测下儿童继发性癫痫的手术治疗效果。方法124例继发性癫痫患儿,术中通过皮层脑电图定位癫痫灶,显微手术切除原发病变后,再根据癫痫发作的临床表现、病灶部位及皮层脑电图监测所提示的异常脑电图波释放决定是否进行致痫灶切除、扩大致痫灶切除、皮层热灼术、前颞叶切除术、海马杏仁核切除术及胼胝体前部切开术。术后规范应用抗癫痫药物。结果124例患儿切除病变前皮层脑电图均可记录到癫痫波,原发病变切除后即时皮层脑电图监测病变周围可记录到异常癫痫波112例,检出率为90.32%。其中38例致痫波发放区域位于非功能区者该范围内皮层予以完全切除,术后即时皮层脑电图提示癫痫波消失;74例位于或毗邻重要功能区者,采用低功率热灼该处皮层后,69例癫痫波消失,5例患者经联合胼胝体前部切开和(或)海马、杏仁核切除,术后即时皮层脑电图监测效果满意。术后随访18个月至6年,按Engle标准评定疗效:Ⅰ级87例(68.50%),Ⅱ级30例(24.19%),Ⅲ级5例(4.03%),Ⅳ级2例(1.61%);手术总有效率为94.35%。89例患者停止服用抗癫痫药物满1年且无癫痫发作;24例患者低剂量维持;11例患者停药后癫痫复发再次服用初始量,发作频率较术前明显减少。结论皮层脑电图监测下,不同术式应用可明显提高儿童继发性癫痫手术治疗的效果。
Objeetive To investigate the efficiency of surgical management for children with sec- ondary epilepsy under the monitoring of electroencephalogram（CEEG）. Methods The monitoring of ECoG was performed in 124 patients to locate the epileptic loci before the resection of the primary lesion. The resection of epileptic foci, the enlarged resection of epileptic foei, cortical thermocoagulation, anterior temporal lobectomy, amygdalohippocampectomy and anterior callosotomy should be underwent according to the clinical manifestations of seizure, the location of lesion and epileptic waveform discharges detected by intraoperative CEEG monitoring after the resection primary lesion. The antiepileptic drugs （AEDs） were postoperatively taken. Results The epileptic wave form discharges were detected before the resection of primary lesion in 124 patients, The epileptic wave were founded in 112 patients at the peripheral areas of the primary nidus in immediately postoperative CEEG monitoring （90.32 %）. Epileptic wave disappeared on immediately postoperative CEEG monitoring in 38 patients whose lesion located in nonfunctional area after the resection of residual cortical zone with epileptic wave discharge. The monitoring of ECoG was normal in 69 patients after cortical thermocoagulation were performed in 74 patients whose the epileptic wave discharge cortical zone was located or neighbor in functional area. The good immediately postoperative CEEG monitoring was founded in 5 patients after combined anterior callosotomy and/or amygdalohippocampectomy. The AEDs were postoperatively taken for all patients. The follow--up studies from eighteen months to six years showed that there were grade I in 87 cases （68.50%）, grade II in 30 cases （24.19%）, grade iiI in 5 cases （4.03%）, grade IV in 2 cases （1.61%） according to Engle standard, the total effective rate was 94.35%. There were no seizure attack in 89 cases after withdrawing the AEDs for one year, low main- tenance dosage in 24 cases, initial dosage were repea
出处
《贵州医药》
CAS
2013年第1期19-22,共4页
Guizhou Medical Journal
基金
贵州省卫生厅项目[项目编号:GZWKJ(2010)-1-008]
关键词
皮层脑电图
不同术式
儿童
继发性癫痫
手术治疗
Electroencephalogram（CEEG） Different surgical procedures Children Secondary epilepsy Surgical management
