后皮质癫痫的临床特征分析与手术治疗

Clinical features and surgical treatment for posterior cortex epilepsy

目的探讨后皮质癫痫的临床定位特征与手术治疗方法。方法根据临床确诊为后皮质癫痫的43例患者完整的临床资料，回顾性分析其发作症状、影像学、脑电图及神经病理学等方面的临床特征，并总结手术治疗的疗效与并发症。结果43例患者中顶叶癫痫11例，枕叶癫痫13例，其余部位癫痫19例，33例（76．7％）出现先兆症状，发作期常常表现为头或眼向对侧转动、伴自动症、特定的姿势性强直等症状学特点。22例需埋置颅内电极。术后5例出现不同程度的视觉障碍。随访1～5年，27例（62．8％）癫痫发作消失。结论某些先兆和发作期症状可能提示癫痫灶位于后皮质，部分患者可以通过手术获得满意疗效。

Objective To characterize the clinical features and assess the role of surgery in posterior cortex epilepsy. Methods A retrospective analysis of clinical data was performed in 43 patients with posterior cortex epilepsy. The diagnosis was established by means of a standard presurgical evaluation, including ictal semiology, MRI, interictal and ictal scalp video-EEG, and additional intracranial EEG monitoring in selected cases. Results The 43 patients included 11 parietal lobe epilepsy, 13 occipital lobe epilepsy, and 19 patients with seizures originating from other part of posterior cortex. Thirty-three patients （76.7%） experienced at least one type of aura, such as visual aura, somatosensory aura, dizziness and so on. The common ictal manifestations included deviation, automatisms, tonic posture and so on. Intracranial EEG monitoring was preformed in 22 selected cases. Transient contralateral hemiparesis occurred in 2 patients, mixed aphasia in 1 patient, and they recovered in 3 weeks after surgery. Visual and visual field deficits were observed in 5 patients, and they did not fully recovered. All patients were followed-up 1 to 5 years, and 27 （62.8 % ） became seizure free （ Engel＇ s Ⅰ class）. Conclusions Some of the specific auras or ictal manifestations may indicate posterior cortex epilepsy. Favorable surgical outcome has been achieved in many of the patients.