111例颞叶癫痫患者VEEG、MRI与^1HMRS的对比研究

The Comparison between VEEG, MRI and ^1HMRS in 111 Temporal Epilepsy Patients

目的:通过对颞叶癫痫患者视频脑电图(VEEG)、核磁共振(MRI)和氢质子波谱分析(1HMRS)的对比研究,评价1HMRS在癫痫灶定位诊断的价值。方法:111例癫痫患者均行24小时VEEG、双侧颞叶单体素1HMRS、MRI检查,比较患者发作期及发作间期异常脑电图出现的部位与1HMRS异常部位的相关性;比较MRI与1HMRS在颞叶癫痫患者的定位诊断意义。结果:111例患者中未出现临床发作共75例,其中有73例VEEG异常,占患者总数的65.76%,有36例出现临床发作,占患者总数的32.43%;MRI异常率为26.13%;1HMRS异常率为49.55%,其中双侧异常率为27.27%。发作间期VEEG异常的73例患者中与1HMRS异常部位完全或基本符合为16例,符合率为21.92%;发作时VEEG异常36例患者中与1HMRS异常部位完全或基本符合为23例,符合率为63.89%;MRI异常的29例患者中有颞叶病变13例,病变部位1HMRS均异常,且与脑电图出现的颞叶癫痫波一致;非颞叶病变的患者共16例,其中9例1HMRS异常;MRI正常的82例患者中有33例1HMRS异常,且与脑电图出现的颞叶癫痫波一致。结论:MRI颞叶信号异常的出现晚于颞叶代谢异常所致的1HMRS异常,因此1HMRS在颞叶癫痫定位诊断方面较MRI更有意义。1HMRS与VEEG电活动异常呈正相关。临床上应当结合VEEG、MRI等检查结果进行综合分析,以提高致痫灶定位的准确性,为开展外科手术提供强有力的依据。

Objective： To evaluate ^1HMRS in localization of temporal epilepsy through comparison between VEEG, MRI and ^1HMRS. Methods： All of the 111 temporal epilepsy patients finished VEEG, MRI and tHMRS and we tried to find at the relation of localization by comparison VEEG （paroxysm period and paroxysm interval period） and ^1HMRS and to contrast diagnostic mean- ing between MRI and ^1HMRS. Results： There was 75 patients who didn＇t break out. Among them 73 have abnormal VEEG and the rate was 65.76% ; there were 36 patients who had clinical spasm and the overall rate was 32.43% ; MRI abnormal rate was 26.13% ; ^1HMRS abnormal rate was 49.55%, and bilateral abnormality accounted for 27.27%. In 73 patients of VEEG abnormality in outbreak interval period, 16 accorded with 1HMRS localization and accounted for 21.92% ; In 36 patients of VEEG abnormality in paroxysmal period, 23 Conformed to ^1HMRS localization and accounted for 63.89% ; In 29 MRI abnormal patients, there were 13 who had pathological changes in the temporals and their ^1HMRS were exceptional and consistent with VEEG; rest of the patients was 16 and of them 9 had exceptional ^1HMRS. In 82 patients with normal MRI, 33 had exceptional ^1HMRS results. Conclusion： ^1HMRS was earlier than MRI in temporal abnormal changes and ^1HMRS has more meaning than MRI in epilepsy localization. ^1HMRS has high consistency with VEEG. In clinical work we should combine VEEG with MRI to analyse, so that we could improve the accunacy to locahged the focus and provide solid basis for surgeryical treatment of epilepsy.