摘要
目的探讨立体定向脑电图对头皮脑电图提示双侧颞叶癫痫患者的定侧评估价值及手术疗效。方法回顾性分析2014年1月至2015年12月上海交通大学医学院附属仁济医院功能神经科对10例头皮脑电图提示双侧颞叶癫痫患者的临床特征以及进行双侧颞叶立体定向脑电图监测评估的结果。根据监测结果，对单侧颞叶癫痫患者进行单侧前颞叶＋海马杏仁核切除术；对双侧独立起源、双侧颞叶问起源有明显差别的患者行主要侧别前颞叶＋海马杏仁核切除术；若双侧无明显差别则行神经调控治疗。结果立体定向脑电图监测发现，10例患者中7例为单侧颞叶发作起源并快速传播至对侧，3例为双侧颞叶独立发作起源，其中1例双侧间有明显差别。8例行前颞叶＋海马杏仁核切除术的患者，术后6例疗效达到EngelⅠ级，2例为EngelⅡ级；2例行神经调控治疗的患者，疗效为Engel分级Ⅲ级。结论头皮脑电图提示的双侧颞叶癫痫中大部分为单侧颞叶起源，前颞叶＋海马杏仁核切除术可达到较好效果；而立体定向脑电图是一种鉴别双侧颞叶癫痫侧别安全、有效的方法。对于双侧独立起源的颞叶癫痫，切除主要侧颞叶可获得一定疗效；而对于双侧无明显区别的颞叶癫痫，神经调控治疗可减少部分发作。
Objective To explore the lateralizing value of stereotactic electroencephalography （SEEG） in bilateral temporal lobe epilepsy （BTLE） suggested by scalp EEG and to assess the surgical outcomes. Methods A retrospective study was conducted on the clinical features and SEEG monitoring results of 10 patients who were diagnosed as BTLE based on scalp EEG and underwent SEEG implantation from January 2014 to December 2015 at Renji Hospital, School of Medicine, Shanghai Jiaotong University. According to the SEEG results, anterior temporal lobectomy with amygdalohippocampectomy （ATL-AH） was performed for unilateral temporal lobe epilepsy （UTLE） and BTLE with unilaterally dominant epileptic focus, and neuromodulation was performed for BTLE without unilaterally dominant epileptic focus. Results SEEG monitoring data revealed UTLE in 7 out of the 10 patients and BTLE in the other 3 patients including 1 with unilaterally dominant epileptic focus. Among the 8 patients undergoing ATL-AH, 6 patients were classified as Engel I and 2 as Engel U post surgery. Neuromodulation was performed in 2 patients and both reported an Engel class III outcome. Conclusions In patients with BTLE suggested by scalp EEG, unilateral onset might be identified in most cases which could achieve good surgical outcomes following ATL-AH. SEEG seems to be a safe and effective method to lateralize BTLE as indicated by scalp EEG. Patients with UTLE and BTLE with unilaterally dominant epileptic focus could obtain good outcomes （Engel class I and II） post ATL-AH. Moreover, neuromodulation seems to be an effective therapy for BTLE without unilaterally dominant epileptic focus.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第6期569-573,共5页
Chinese Journal of Neurosurgery
基金
中国抗癫痫协会科研基金（2017013）
上海市科委基础处重点项目（13DJ1400301）
关键词
癫痫
颞叶
立体定向脑电图
神经外科手术
评价研究
Epilepsy, temporal lobe
Stereoelectroencephalography
Neurosurgical procedures
Evaluation studies
