枕叶癫痫21例报告

Areportof21casesofociptallobeepilepsyLiLing.DepartmentofNeurosurgery

为了探讨枕叶癫痫的临床特征，对２１例枕叶癫痫患者的临床发作特征（视觉发作、偏转发作、自动症和全身大发作）进行评估，并比较了头皮ＥＥＧ和颅内ＥＥＧ对枕叶癫痫的诊断价值。结果发现，起于抽搐的对侧者１１例，１０例有同侧偏转。头皮ＥＥＧ罕有助于枕叶癫痫的定位，且常常是错误的。颅内ＥＥＧ记录可正确证实枕叶异常放电的起源，且有Ｓｙｌｖｉａｎ裂的内侧或侧方上下不同癫痫扩散类型。２０例作了ＣＴ、ＭＲＩ及单光子发射断层扫描（ＳＰＥＣＴ）检查，证实有枕叶病变，１例只作了ＣＴ与ＳＰＥＣＴ检查证实。１９例作了病变及致痫灶切除，２例作了颞叶切除。手术结果：除１例因智能低下需照料外，均获得良好效果，随访２～５年，２０例均已恢复学习或工作。结果提示，枕叶癫痫虽表现复杂，甚或导致错误的诊断，但如注意到早期发作先兆或症状，应用ＣＴ、ＭＲＩ、ＳＰＥＣＴ及颅内电极记录，常可作出正确诊断。手术结果是满意的。

caseswithoccipitallobeepilepsyarereported.Theobjectiveofthisstudyistoprobeintotheclinicalcharacteristicsofthepatientswithociptallobeepilepsyandtofacilitatethecorectdiagnosesandpropertreatment.Thecharacteristicsofalmostaltheclinicalseizuressuchasvisualseizures,deviationseizures,automatismandgeneralizedepilepsy,canbeusedfortheevalua-tionofthe21cases.11casesoftheseisureswereobservedfrequentlyonthecontralateralsides,but10casesexhibitedipsilateraldeviations.ThescalpEEGfindingswereseldomofhelpforthelocaliza-tionoftheoccipitallobelesionsandfrequentlyprovedtobemisleading.IntracranialEEGrecordingcorectlyidentfiedthevariabilityintheseizurecharacteristicsrelatedtodiferentseizurespreadings,whethertheyweremedialyorlateralylocatedandaboveorbelowtheSylvianfissures.20caseswerestudiedwithCTscanning,MRIandSPECTinordertodemonstratetheocipitallesions.1casewasstudiedwithCTscanningandSPECTonly.19casesweretreatedoperatively,thelesionsandepileptogenicfocibeingremoved,and2caseshadtemporallobectomy.Alofthepatientshadtheirseisuresrelievedexceptfor1patientwithlowerinteligencesothathehadtobenursedbyhisfamilymembers.20patientsrecoveredsatisfactorilyfromtheirilnesandcouldgotoschoolorwork.Thefolow-upperiodwasfrom2to5years.Althoughcomplexandsometimesmisleadingfindingscouldbeasociatedwiththeseizuresoriginatingintheoccipitallobe,yettheepilepticauraorsymptonswerenoticedcarefulyandearlier,examinationwithCT、MRI、SPECTorintracranialelectrodesrecordingcouldoftenbeappliedtoobtaincorectdiagnosis,andrathergoodresultscouldusualybeachievedwithoperation.