低剂量立体定向适形光子刀治疗原发性癫痫

Low-dose Stereotaxic Photon Knife for Primary Epilepsy

目的 探讨利用低剂量立体定向光子刀治疗原发性癫痫的方法及其疗效.方法 放射治疗组均为长期低频率大发作,又不愿长期、坚持服用抗癫痫药物的原发性癫痫患者.经视频脑电图对癫痫灶定位后,以12Gy总剂量,利用立体定向适形光子刀系统对癫痫灶进行照射.每位治疗患者选1名一般条件基本相同,接受丙戊酸钠正规治疗门诊患者为对照,对照组与治疗组以1：1配对.结果 患者经放射治疗后随访12～37个月,以Engel分级评价疗效,Engel Ⅰ级1例（9.1%）,Ⅱ级2例（18.2%）,Ⅲ级6例（54.5%）,Ⅳ级2例（18.2%）.在随访期内均未出现放疗反应和其他并发症.与对照组相比,有统计学意义（μ=2.051,P＜0.05）.结论 经过对癫痫灶非毁损性低剂量、区域照射,部分患者疗效良好,随访期内未发现明显不良反应.提示该法是一种微创、有效的治疗方法.

Objective To study stereotaxie photon knife with low doses for the therapy of primary epilepsy and evaluate its efficacy, Methods Patients with primary epilepsy, who did not want to take anti-epilepsy drugs continuously and regularly, were included in therapeutic group. After the epileptic focus was located through video electroencephalography, radiation with a total dose of 12 Gy was applied to the epileptic region by the stereotaxie photon knife. The general condition matched patients who received regular val- proate therapy from out - patient department were selected as controls, and the controlled patients vs. the therapeutic ones were pair - matched （ 1 ： 1 ）. Results All of the patients were followed up for 12 - 37 months. No abnormal reaction to radiotherapy or other complication was documented. As for the outcome, one case got to Engel Class Ⅰ after radiation, two to Class Ⅱ, six to Class Ⅲ, and two to Class IV. There existed a statistical difference when they were compared with those of the control group. Conclusion The effectiveness of non-destroyed and local radiation on epilepsy focus is satisfactory in part of the patients. No obvious side effect was found during the follow-up period. That is to say, this modality is minimally invasive and effective.