有效控制与控制不良的特发性全面性强直阵挛发作癫癎患者局部脑血流的对照研究

Control study of regional cerebral blood flow in both effective treated and incomplete controlled patients of idiopathic generalized tonic clonic seizure

目的 探讨有效控制与控制不良的特发性全面性强直阵挛发作癫 (GTCS)患者局部脑血流的差异 ,为评价癫预后和合理治疗提供依据。方法 对 2 9例有效控制的特发性GTCS患者和 12例控制不良的特发性GTCS患者进行发作间期单光子发射计算机断层 (99mTc ECD SPECT)脑血灌流显像 ,用感兴趣区 (ROI)方法对两组的局部脑血流 (rCBF)分布进行半定量分析 ,并将两组患者低局部脑血流的比率 (异常率 )与临床癫发作次数、脑电图 (EEG)进行比较。结果 ROI分析显示 12例控制不良的特发性GTCS患者大脑基底节区和丘脑的rCBF明显低于 2 9例有效控制的特发性GTCS患者大脑的相应脑区血流量 (P <0 0 5 )。有效控制组SPECT脑显像出现低血灌注区的异常率 (1/ 2 9)明显低于控制不良组 (9/ 12 ) ,两组具有显著性差异 (P <0 0 5 ) ;而两组患者的EEG异常率分别为 13/ 2 9、7/ 12 ,差异不具有显著性意义 (P >0 0 5 )。结论 控制不良的GTCS基底节及丘脑局部脑血流降低者明显多于有效控制的GTCS ;特发性GTCS患者发作间期大脑低血灌流区可能是亚临床病灶或是长期癫发作的脑损伤区。

Objective To explore sub-clinical items in evaluating the prognosis of epileptic patients,the study on differences of regional cerebral blood flow (rCBF) in both effective treated and incomplete-controlled patients with idiopathic generalized tonic clonic seizure (GTCS) was carried out.Methods Interictal rCBF measurements using 99m Tc-ethyl cysteinates dimmer (ECD) SPECT was performed on 29 effective treated idiopathic GTCS patients and 12 incomplete controlled idiopathic GTCS patients. The rCBF distribution was semi-quantitatively analyzed by regions of interest (ROIs) comparing with abnormal rate of interictal hypoperfusion rCBF,clinical seizure time and EEG.Results ROI analysis showed that rCBF decreased in basal ganglia and thalamus of incomplete controlled patients with idiopathic GTCS compared to that of effective treated ones′ significantly ( P <0.05). The abnormal rate of hypoperfusion rCBF in incomplete controlled patients with idiopathic GTCS was higher than that of effective treated ones significantly (1/29 vs 9/12, P <0.05),while there was no dramatic difference in EEG between two groups.Conclusion The number of incomplete controlled patients with hypoperfusion rCBF in basal ganglia and thalamus is higher than that of effective treated ones. The interictal hypoperfusion rCBF in idiopathic GTCS might indicate a sub-clinical focus or injured cerebral zone caused by long-time epileptic seizures.