癫痫性痉挛发作的外科治疗.pdfVIP

Tsinghua University Affiliated Yuquan Hospital, , Beijing, 100049. [Abstract] Objective: To analyze Ictal electrographic changes on scalp and intracranial EEG in patients with medically refractory epileptic spasms, and to assess the changes of ictal discharges associated with spasms and their relation to interictal epileptiform activity and neuroimaging. Methods: We analyzed 82 seizures from 11 patients, aged 1~19 years. 11 patients performed with intraoperative electrocorticography (EcoG). Ictal events were also analyzed with intracranial EEG from 4 patients, which were being performed for cortical resection. Results : For patients with EcoG monitoring, apart from diffuse sporadic spikes, they also displayed with continous or frequent rhythmic epileptogenic discharges (CED) recorded from cortex with MRI lesion. For patients with chronic intracranial EEG monitoring, spasms were associated with either a “leading” spike followed by fast-wave bursts or fast-wave bursts without a “leading” spike. To resect the associated cortex may achieve good surgical outcome. Fast-wave bursts were associated with spasms. Conclusion : Epileptic spasms may be triggered by a focal neocortical impulse in a subset of patients, and a leading spike might be used as a marker of the trigger zone for epileptic spasms. Rapidly emerging widespread fast-wave bursts might explain the clinical semiology of epileptic spasms. Completeness of excision of cortical tissue displaying CED corrlated with good surgical outcome. [ Key words] Epilepsy Surgery, Epileptic Spasms, Scalp EEG, Intracranial EEG. 背景 癫痫性痉挛发作常常起病于3 －12 个月的婴儿期，过去统称为“婴儿痉挛症” 或“West 综合症”，其主要表