外伤性癫痫治疗的临床探讨

Clinical Investigation on Treatment of Post-traumatic Epilepsy

目的探讨外伤性癫痫的高危因素、临床特征、预防及治疗方法等。方法我科自2000年1月到2006年3月收治86例外伤性癫痫患者,均常规给予抗癫痫药物治疗,其中手术治疗21例。手术患者采取致痫灶切除术6例,致痫灶切除+多处软膜下横切术(MST)/热灼术11例,前颞叶、杏仁核-海马切除2例,选择性杏仁核-海马切除1例,胼胝体切开+MST+皮层热灼1例。结果随访6～58月,65例保守治疗者中,28例在服药治疗两年以上后逐步减药直至停药,未见癫痫明显发作;其余患者仍继续口服药物治疗,8例仍时有发作。21例手术治疗患者,术后癫痫控制满意9例(42.7%),显著改善8例(38.1%),良好2例(9.6%),效果较差1例(4.8%),无改善1例(4.8%)。无手术死亡及永久性并发症发生。结论外伤性癫痫的预防首先应去除诱因,对有高发风险者可予以预防性抗癫痫药物治疗。准确的术前评估、术中ECoG监测、多种术式的联合应用可提高外伤后癫痫患者的手术疗效。

Objective To investigate the risk factors, clinical characteristics, prevention and the treatment of post-traumatic epilepsy （PTE）. Methods Of 86 patients with PTE treated in our department from January 2000 to March 2006, 65 only received antiepileptic drugs （AEDs） treatment and 21 received operations treatment besides AEDs treatment. Of 21 patients who underwent surgery, 6 received the resection of the epileptogenic foci, 11 the resection of the epileptogenic foci and multiple subpial transection （MST） or bipolar coagulation of functional cortexes, 2 anterior temporal lobectomy and amygdalo-hippocampectomy, 1 selective amygdalo-hippocampectomy, and 1 anterior callosotomy, MST and bipolar coagulation of the functional cortexes. Results All the patients with PTE were followed up from 6 to 58 months after the treatment. In 65 patients treated only with AED, the epilepsy was controlled after AEDs withdrawal in 28 patients with PTE receiving AEDs treatment for 2 years, and the other patients still took AEDs and there still were the intermittent seizures in 8 patients. Of 21 patients with PTE undergoing the surgery, 9 had satisfactory outcome, 8 marked improvement in the seizure, 2 improvement, 1 slight improvement and 1 little improvement. No death and permanent functional disturbance occurred due to the operation. Conclusions The measures to prevent PTE include the removal of the factors inducing the epilepsy and preventive application of AEDs in the patients with risk factors inducing epilepsy in the posttraumatic first week. The accurate preoperative evaluation, intraoperative electrocorticogram monitoring and combined operations are the key to the guarantee of the ideal curative effect in the patients with PTE.