37例颞叶相关癫痫手术疗效分析.pdfVIP

postoperative evaluation, nincluding these aspects: neuroimaging, clinical symptoms neuro-electrophysiology and neuropsychology,then analyze the clinical outcome. Results All patients had more than one year follow-up after surgery.We found 18 cases were seizure free (Engel I), seizure frequency reduced markedly in 16 cases (Engel II), 2 cases in Engel III and 1 case had no effect(Engel IV) . Conclusion The main influence factor of surgical outcome in correlated with temporal lobe epilepsy patients was correct interpretation of neuroimaging, clinical symptoms neuro-electrophysiology and neuropsychology. When these aspects were highly consistent in localizing epileptogeniczone and in cases there were neuroimging structural abnormalities,we would find better surgical effect.Severity of epilepsy complications may influence the postoperative effect, less complications, postoperative effect was relatively better. For those cases there were neuroimging structural abnormalities but clinical symptoms were generalized seizures, correct resections also led to good effect. 【Key words 】 Temporal lobe; Epilepsy; Surgical treatment; Electroencephalogram 颞叶癫痫在成人难治性癫痫中最常见，约占 60% 。也是药物最 [1] 难治愈的癫痫之一，外科治疗效果良好 。国际抗癫痫联盟2001 年 对癫痫的分类中，把颞叶癫痫分为了颞叶内侧型和颞叶外侧型即颞 叶新皮层癫痫2 种类型。但我们在实际的临床工作中发现，二者的 严格区分并不容易，且存在一部分颞叶影像学有阳性发现，而临床 发作症状和神经电生理学的表现往往不能提示为颞叶癫痫，但综合 判断高度怀疑颞叶影像学改变与癫痫发作密切相关的患者，因此我 们将这三者统一归类为颞叶相关癫痫。本文初步总结了 2008-2010 年底37 例颞叶相关癫痫的手术资料，对该类癫痫的致痫灶定位与术 前、术后情况进行分析和探讨，分析影响与颞叶相关癫痫患者手术 疗效的相关因素，总结手术成功与失败的经验。 资料与方法 1.一般资料 病例入选标准：1、合理正规抗癫痫药物治疗2 年以上，每月发 作在 2 次以上，严重影响患者的生活质量，经过临床症状学及头皮 视频脑电图监测提示为颞叶癫痫，伴或不伴有颞叶影像学阳性发现。 2、虽无临床症状学及脑电图支持，但颞叶影像学阳性改变高度提示 与癫痫发作密切相关。2008 年3 月～2010 年 12 月符合以上条件的 37 例患者，男22 例，女 15 例，年龄9～55 岁，平均29 岁。病程 0.25～40 年，平均 11.7 年。既往史中，婴儿期有高热惊厥史者7 例， 颅脑外伤2 例，脑膜炎或病毒性脑炎史6 例，脑出血史1 例。 2.术前