顽固性癫痫病人术的前综合评估在致痫灶定位中的应用.doc

顽固性癫痫病人术前综合评估在致痫灶定位中的应用 ? 论着? 童签室塑篮墅}垫查年第17卷第2期ChinJStereotactFunctN 顽固性癫痫病人术前综合评估 在致痫灶定位中的应用 侯晓华林志国浦松王春利王天成 2004,Vo1.17,No.2 [摘要】目的探讨常规脑电图(REEG),视频脑电图(VEEG),MRI,SPECT检查对癫痫病的诊断及术前综 合评估在致痫灶定位中的意义.方法对68例顽固性癫痫病人行REEG,VEEG,MRI及SPECT检查,对44例顽 固性癫痫病人术中行皮层电极(ECoG)和深部电极监测,同时对REEG,VEEG,MRI和SPECT用于癫痫病人的诊 断和致痫灶的定位价值进行对比研究.结果68例癫痫患者中REEG局灶棘波检出30例(41.1%),VEEG局灶 棘波检出51例(75%),经统计学分析局灶棘波检出率在两者之间有显着性差异(Plt;0.01).SPECT异常32例 (80%),MRI异常47例(69.1%).在44例行癫痫手术治疗的病人中,ECoG与VEEG定位～致39例(88.7%), 与MRI异常部位一致33例(75%),1例VEEG异常部位与MRI不一致的病例,经ECoG证实致痫灶为VEEG异 常部位.结论VEEG对于癫痫的诊断及致痫灶的定位有相当重要的临床价值,优于REEG和MRI.通过临床表 现,影像学,功能性检查尤其是VEEG联合检查,对顽固性癫痫病人致痫灶的定位具有较大的应用价值. [关键词]顽固性癫痫;REEG;VEEG;MRI;SPECT;癫痫手术;术前综合评估 中图分类号:R742.1文献标识码:A文章编号:1008—2425(2004)02—0070—04 Applicationofpresurgicalcombinedevaluationofintractableepilepsyinlocalizingepileptogenic focusHouXiao]lLla,LinZhig.o,PuSong,eta1.DepartmentofNeurology,ThefAffiliated HospitalofHarbinMedicalUniversity,Heilong/iang150001 [Abstract]ObjectiveToexplorethesignificanceofrouting—EEG(REEG),VEEG,MRIand SPECTindiagnosisofintractableepilepsyandevaluationofpresurgicalepileptogenicfocus.Methods 68patientswithintractableepilepsywerecheckedbyREEG,VEEG,MRIandSPECT,theirresults werecomparedwitheachother.44patientsofthemwereoperatedforepilepsy,duringthesurgery ECoGwasfurtheremployedtOconfirmtheepileptogenicfocus.ResultsInthe68patientswithin— tractableepilepsy,thedetectionrateofepileptogenicfocuseswas44.1%,69.1%,75%,80%by REEG,MRI,VEEG,SPECTrespectively.TherewasasignificantdifferencebetweenREEGand VEEG(Plt;0.01).In44patientswithsurgicaltreatment,seizurelocalizationbyVEEGwereconsis tentwiththosebvECoGabout88.7%,whilewereabout75%byMRI,1patientwithdifferentfocus bvVEEGandMR1wasconsistentwithVEEGconfirmedbyECoG.ConclusionVEEGcanplaya importantroleinthediagnosisofepilepsyandthelocalizationoftheepileptogenicfocus,whichwas moreexcelientthanothers.Tilecombinedapplicationofclinicalmanifestation,imagingandEEGtOlo calizingepileptogenicfocushasamoreimportantvalue? [Keywords]Intractableepil