难治性颞叶癫癎患者海马病理研究

Significance of hippocampal pathological study in patients with medically intractable temparol lobe epilepsy

目的:探讨海马硬化和难治性颞叶癫的因果关系。方法:对8例海马硬化患者和7例非海马硬化患者临床资料、手术疗效和海马病理改变进行对比和相关分析。结果:海马硬化组较非海马硬化组病程长,疗效显著,疗效分级与最初脑损伤发生年龄呈正相关。海马硬化组和非海马硬化组均有CA1,CA3锥体细胞和颗粒细胞脱失,海马硬化组更明显。门区神经元脱失仅在海马硬化组可见。海马神经元脱失与脑损伤发生年龄呈正相关。结论:生命早期的脑损害是海马硬化的成因。硬化海马是难治性癫的致灶。以海马结构齿状回门区神经元,颗粒细胞和海马CA3锥体细胞脱失为特点的海马硬化是难治性颞叶癫的主要病理特点和病因,门区细胞的脱失是海马硬化的特征性病理改变,可能在难治性癫的发病机理中起着重要作用。

Objective： To study the cause-and-effect relationship between hippocampal sclerosis （HS） and medically intractable temparol lobe epilepsy. Methods：Comparitive and correlative analysis on clinical data are made with operation outcome and hippocampal pathology of 8 HS patients and 7 non-HS patients. Results：The history of seizures was longer and the operation outcome was better in HS group than in non-HS group. Positive correlation was found between operation outcome class and age at intitial precipitating injury （IPI）. CA1, CA3 pyramidale cells in hippocampus and granule cells in fascia dentate all decreased in HS patients and non-HS patients. Neuron loss of hilus cells was only found in HS patients. Positive correlation was found between neuron loss in hippocampus and age at IPI. Conclusion：The cause of HS is IPI in earlier life. HS is the epileptogenic lesion of medically intractable temparol lobe epilepsy. HS with the feature of neuron loss of CA1, CA3 pyramidale cells in hippocampus and granule cells, hilus cells in fascia dentate is primary pathology and cause of medically intractable temparol lobe epilepsy. Loss of hilus cells is the most important pathology of HS, which possibly plays an important role in medically intractable epilepsy （MIE）.