摘要
目的探讨快速停用抗痫性发作药物致可逆性胼胝体压部病变(RSLCC)的患者的影像学表现和临床特征。方法回顾性分析北京协和医院2例癫痫患者在行长程视频脑电图监测过程中快速停用抗痫性发作药物后的临床表现及影像学特征,并进行文献复习。结果2例患者均在停药后数天内因术前评估需要作常规头部MRI检查,结果显示为胼胝体压部局限性、可逆性病灶,T1WI上表现为胼胝体压部圆形或类圆形的孤立性稍低信号,T2WI及FLAIR为高信号,DWI信号较高,对应部位ADC信号减弱,灶周未见明显水肿及占位效应。由于2例患者均无明显不适主诉,故未予特殊治疗。病例1在2周后复查头颅MRI发现胼胝体压部病灶完全消失;病例2在4周后复查头颅MRI发现病灶消失。通过文献复习,共搜集到13篇英文文献,总计16例RSLCC患者,均为癫痫患者快速停药后发病,其中男女比例为1∶1,平均年龄31岁,无症状者接近50%,胼胝体压部病变的持续时间平均为66 d。结论癫痫撤药致RSLCC患者的临床表现多样,若患者无不适主诉可不予特殊处理。头颅MRI提示病灶可逆,具有自限性,预后良好。
Objective To investigate the imaging and clinical features of reversible splenial lesions of the corpus callosum(RSLCC)caused by anti-seizure medication withdrawal.Methods The imaging features and clinical manifestations of 2 patients with epilepsy after rapid withdrawal of anti-seizure medication in the long-term video EEG were analyzed retrospectively,and the literatures were reviewed.Results Both patients were given with routine head MRI examination due to preoperative evaluation within a few days after anti-seizure medication withdrawal.MRI images showed that there were localized RSLCC.T1 weight imaging(T1WI)showed a round or quasi-circular isolated low signal in the splenium of corpus callosum,while T2WI and fluid-attenuated inversion recovery(FLAIR)exhibited high signals.DWI signal was a little bit high,while ADC signal at corresponding site was reduced,and no obvious edema and space occupying effect was found around the foci.Since there were no obvious complaints of discomfort from two patients,no special treatment was given.Case#1 was reexamined at 2 weeks later and MRI images showed that the lesions in the splenium of corpus callosum completely disappeared.Case#2 was reexamined after 4 weeks and head MRI images showed that the lesions disappeared.A total of 13 English literatures were reviewed,including 16 patients with RSLCC.All of them were the patients with epilepsy who got onset after rapid withdrawal of anti-seizure medication.Among them,the ratio of male to female was 1∶1,and the average age was 31 years old.The asymptomatic patients took accounted for 50%.The average course of splenial lesions of corpus callosum was 66 days.Conclusion Clinical manifestations of RSLCC caused by withdrawal of anti-seizure medication are diverse.Special treatment is not needed if the patient has no complaint.Head MRI images reveal that the lesions are reversible,self-limiting and patients tend to have a good prognosis.
作者
陈立新
陈新焰
刘琦
郭金竹
郭毅
卢强
周祥琴
有慧
窦万臣
CHEN Lixin;CHEN Xinyan;LIU Qi(Department of Surgery,PUMCH,PUMC&CAMS,Beijing(100730),Beijing,China)
出处
《癫痫与神经电生理学杂志》
2023年第2期99-105,共7页
Journal of Epileptology and Electroneurophysiology(China)
基金
中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-018)。
关键词
癫痫
撤药
可逆性胼胝体压部病变
抗痫性发作药物
epilepsy
drug withdrawal
reversible splenial lesions of the corpus callosum(RSLCC)
anti-seizure medication(ASM)
