PET与MEG定位伽玛刀治疗顽固性癫痫临床及脑电图研究

Clinic and EEG study of gamma knife treatment on intractable epilepsy guided by PET or MEG locating epileptogenic foci

目的评估PET与MEG定位、伽玛刀治疗顽固性癫痫临床效果和脑电图变化。方法Leksell-C型伽玛刀治疗难治性癫痫33例,30例获得随访列入研究,EEG检查26例异常。分为PET组(22例)和MEG组(8例),发作频率分别为4.8±1.9次/月和4.6±2.2次/月。根据癫痫发作特点、脑电图、PET或脑磁图、CT或MRI定位致痫灶。周边剂量为8～13Gy,中心剂量为16～45Gy,照射范围略大于PET和MEG所提示的致痫区范围。术后每3个月复查EEG,并对照术前EEG,观察癫痫发作控制情况,按国际癫痫学会分类法分为6级进行疗效判定。结果随访时间6～19个月,Ⅰ～Ⅱ级10例(33.3%),Ⅲ～Ⅳ级14例(46.7%),Ⅴ级4例(13.3%),Ⅵ级2例(6.7%)。总有效率80.0%。PET与MEG两组病例癫痫发作频次皆较术前明显减少,术后12个月分别降至2.0±1.3次/月和1.8±1.1次/月。随访EEG逐渐恢复正常12例(48.0%),好转9例(36.0%),无变化2例(8.0%),恶化2例(8.0%)。PET与MEG两组之间在治疗前后都没有差别。结论PET或MEG定位致痫灶,伽玛刀治疗顽固性癫痫疗效肯定,EEG可以在术后随访中发挥作用。

Objective To evaluate the clinic effect and EEG changes in intractable epilepsy treatred by gamma knife guided by PET or MEG locating epileptogenic loci. Methods Thirty-- three cases of intractable epilepsy were treated by Leksell--C gamma knife, and 30 of them with follow--up data were analysed in this clinic trial. By way of EEG examination, 26 patients showed the abnormal recordings. The epileptogenic loci were determined with PET in 22 cases and with MEG in 8 cases, classified as PET group and MEG group, with seizure frequency 4.8±1.9 and 4.6±2.2 per month respectively. The target was localized by characteristic of epileptic seizure, EEG, PET/CT or magnetic encephalography, CT or MRI. 8-13Gy peripheral dose and 16-45Gy center dose were managed. The radiation area was a little larger than that PET or MEG indicated as epileptogenic loci. The effects of gamma knife treatment were valuated according to the EEG data after radiosurgery with interval period of 3 months. The efficancy of radiosurgery with gamma knife were classified as grade Ⅰ to Ⅵ with the standard of internationd epilepsy association. Results In 6-19 months of follow-up, there were 10 cases（33.3%） with free from seizure （grade Ⅰ-Ⅱ ）, 14 cases （46.7%） with a little seizures （grade Ⅲ-Ⅳ）, 4 cases （13.3%） with seizures as pre-radiosurgical treatment （grade V） and 2 cases （6.7%） with increasing of seizures （gradeⅥ）. The total effective rate was 80.0%. A markedly decreasing of seizure was found after 6 months follow--up in both PET and MEG groups （P〈0.01）, decreasing to 2.0±1.3 and 1.8±1.1 per month after 12 months respectively. According to EEG follow up data, there were 12 cases （48.0%） with normal recording, 9 cases （36.0%） with improving recording, 2 cases （8.0%） with no change of recording and 2 cases （8.0%） with more seizures recording. A significant decreasing of seizures on EEG recording was seen between before radisurgery and after 3 months follow--up. No significant difference was seen between PET and MEG locaIizing epileptogenic loci. Conclusion Gamma knife could achieve satisfactory effect in trea tingintractable epilepsy with PET or MEG localizing epileptogenic loci, and EEG examination could play important role in the follow--up.