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目的观察难治性颞叶癫痫(intractable temporal lobe epilepsy,ITLE)患者头皮脑电发作起始形式,并探讨其与致痫病变的关系。方法回顾性分析我院神经外科2011年9月至2015年9月45例ITLE患者的临床信息及其172次临床发作的视频脑电图资料,所有病例行切除性癫痫手术治疗,术后效果评估均为EngelⅠ级。根据术前MRI所示致痫病变部位的不同分为颞叶内侧癫痫(mesial temporal lobe epilepsy,MTLE)和颞叶新皮层癫痫(neocortical temporal lobe epilepsy,NTLE);术后病检可见6种不同病理类型。对发作期脑电起始形式进行分析,比较各种起始形式在不同部位及不同性质致痫病变的出现差异,探讨不同发作起始形式对致痫灶的定位价值及可能的神经电生理机制。结果 (1)45例患者172次临床发作期脑电中有明显起始形式157次,包括低幅快活动(low-voltage fast activity,LVFA)57次(36.3%),θ节律35次(22.3%),δ活动31次(19.7%),尖波活动20次(12.7%),低中幅多棘波14次(8.9%)。157次发作期脑电中局灶性起源103次(65.6%),LVFA占49次(47.6%),LVFA的定位率明显高于其他起始形式(P<0.01)。(2)5种起始形式均可见于MTLE和NTLE,LVFA在NTLE的出现率明显高于MTLE(P<0.01),慢活动(θ节律及δ活动)在MTLE的出现率高于NTLE(P<0.05),尖波活动及低中幅多棘波在不同部位的出现差异无统计学意义(P>0.05)。(3)5种起始形式可见于不同性质的致痫病变,θ节律在海马硬化(hippocampal sclerosis,HS)病变中的出现率高于其他病变类型(P<0.05)。结论 ITLE发作期头皮脑电起始形式中LVFA有较好定位价值,θ节律对HS具有提示意义。
Objective To observe the onset of electroencephalogram (EEG) in patients with intractable temporal lobe epilepsy (ITLE) and discuss the relationship between them and the development of epilepsy. Methods The clinical information of 45 patients with ITLE and the clinical data of 172 clinical seizures from September 2011 to September 2015 in our department of neurosurgery were analyzed retrospectively. All patients underwent surgical resection of epilepsy and postoperative evaluation All Engel Ⅰ level. According to the preoperative MRI, the epileptogenic lesions were divided into mesial temporal lobe epilepsy (MTLE) and neocortical temporal lobe epilepsy (NTLE). Six different pathological changes Types of. The onset of EEG at the onset of the form were analyzed to compare various starting forms in different parts and different nature of epileptiform lesions appear to explore the onset of different forms of epileptogenic lesions and the potential value of the electrophysiological mechanism . Results (1) In 45 patients, there were 157 initial episodes of EEG in 172 clinical episodes, including 57 low-voltage fast activity (LVFA) of 57 (36.3%) and θ rhythm of 35 %), 31 events (19.7%), 20 events (12.7%) and 14 events (8.9%). There were 103 episodes (65.6%) and 49 (47.6%) LVFAs in 157 episodes. The localization of LVFA was significantly higher than that of other initial forms (P <0.01). (2) The five kinds of initial forms were found in MTLE and NTLE. The incidence of LVFA in NTLE was significantly higher than that in MTLE (P <0.01), and the occurrence of slow activity (θ rhythm and δ activity) in MTLE was higher than that in NTLE <0.05). There was no significant difference in spike activity and low-middle amplitude spike in different sites (P> 0.05). (3) Five kinds of initial forms can be found in epileptogenic lesions with different properties. The incidence of θ rhythm in hippocampal sclerosis (HS) lesions is higher than that in other lesions (P <0.05). Conclusions LVFA has a better localization value in the initial form of scalp EEG during ITLE onset, and θ rhythm has implications for HS.