摘要
目的探讨立体脑电图(SEEG)引导射频热凝(RFTC)毁损治疗药物难治性癫痫的疗效及其相关影响因素。方法回顾性分析2019年6月至2021年6月兰州大学第二医院神经外科收治的36例药物难治性癫痫患者的临床资料。所有患者均设计SEEG电极植入方案,根据SEEG监测信息确定发作起始区并行RFTC毁损。术后通过电话或门诊随访,采用Engel分级评估患者的预后。采用单因素分析和多因素logistic回归分析探讨影响药物难治性癫痫患者预后的因素。结果36例患者接受RFTC毁损治疗后随访(13.7±6.9)个月(6~32个月)。RFTC毁损后2、12、24个月的无癫痫发作率(比例)分别为58.3%(21/36)、30.0%(6/20)和1/7。末次随访结果显示,预后良好(Engel分级Ⅰ、Ⅱ级)17例(47.2%),预后不良(Engel分级Ⅲ、Ⅳ级)19例(52.8%)。单因素分析结果表明,癫痫发作类型为未继发强直-阵挛发作、MRI显示有明显病灶、正电子发射断层显像术(PET)检查结果提示有明显的低代谢区、癫痫发作模式(SOP)为SOP1和SOP2、采用根治性RFTC毁损、RFTC毁损后24 h SEEG显示发作间期异常放电消失可能与患者的良好预后相关(均P<0.05)。多因素logistic回归分析结果显示,MRI显示有明确病灶(OR=40.41,95%CI:2.26~721.27,P=0.012)、PET检查结果提示有明显的低代谢区(OR=26.88,95%CI:1.40~517.65,P=0.029)、RFTC毁损后24 h SEEG显示发作间期异常放电消失(OR=15.14,95%CI:1.57~146.30,P=0.019)为患者预后良好的独立影响因素。结论SEEG引导的RFTC毁损治疗药物难治性癫痫有明显的近期效果;MRI显示有明确致痫病灶、PET检查结果显示有低代谢区、RFTC毁损后24 h SEEG显示发作间期放电消失3个因素可提示接受RFTC毁损治疗的药物难治性癫痫患者具有良好的预后。
Objective To determine the prognosis and its influencing factors of stereoelectroence-phalography(SEEG)-guided radiofrequency thermocoagulation(RFTC)for the treatment of drug-refractory epilepsy.Methods The clinical data of 36 patients with drug-refractory epilepsy treated in the Department of Neurosurgery of the Second Hospital of Lanzhou University from June 2019 to June 2021 were analyzed retrospectively.SEEG electrode implantation scheme was designed in all patients,and the onset area of seizure was determined based on SEEG monitoring information and then RFTC was performed.The patients were followed up by telephone or outpatient service after operation,and the outcome was evaluated by using Engel grading system.Univariate analysis and multivariate logistic regression analyses were used to explore the factors influencing the outcomes of patients with drug-refractory epilepsy.Results Thirty-six patients were followed up for 13.7±6.9 months(range:6-32 months)after RFTC treatment.The seizure-free rates at 2,12 and 24 months after RFTC were 58.3%(21/36),30.0%(6/20)and 14.3%(1/7)respectively.The results of the last follow-up showed that the outcome was good(Engel gradesⅠandⅡ)in 17 cases(47.2%)and poor(Engel gradesⅢandⅣ)in 19 cases(52.8%).Univariate analysis showed that no secondarily generalized tonic-clonic seizures,obvious lesions showed on MRI,obvious hypometabolic areas on positron emission tomography(PET)results,SOP1 and SOP2 patterns of epileptic seizure and disappearance of interictal discharge on 24-h SEEG after thermocoagulation may be associated with the good outcome of the patients.Multivariate logistic analysis showed that clear focus(OR=40.41,95%CI:2.26-721.27,P=0.012)on MRI,obvious hypometabolic area(OR=26.88,95%CI:1.40-517.65,P=0.029)on PET and the disappearance of interictal discharge on 24-h SEEG after thermocoagulation(OR=15.14,95%CI:1.57-146.30,P=0.019)were independent influencing factors of good prognosis.Conclusions SEEG-guided RFTC has obvious short-term therapeutic effect for the tr
作者
严忠辉
韩彦明
杨文桢
史雪峰
王小强
兰正波
杨宝慧
陈念东
张新定
Yan Zhonghui;Han Yanming;Yang Wenzhen;Shi Xuefeng;Wang Xiaoqiang;Lan Zhengbo;Yang Baohui;Chen Niandong;Zhang Xinding(Department of Neurosurgery,Second Hospital of Lanzhou University,Neurosurgery Laboratory,Institute of Neurology,Lanzhou University,Lanzhou 730000,China;Department of Neurosurgery of People′s Hospital of Linxia Prefecture,Linxia 731100,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2023年第12期1267-1271,共5页
Chinese Journal of Neurosurgery
关键词
癫痫
神经外科手术
预后
射频热凝
影响因素分析
立体脑电图
Epilepsy
Neurosurgical procedures
Prognosis
Radiofrequency thermoco-agulation
Root cause analysis
Stereoelectroencephalography
