颞叶癫痫脑电图分析及病灶超微结构观察

Ultrastructure changes in spike focus of temporal lobe cortexes and hippocampus and EEG studies in human brain of temporal lobe epilepsy

目的研究影像学检查无异常的颞叶癫痫患者，电生理异常与皮层棘波灶及海马超微病变的关系。方法选择经CT或MRI检查未见异常的颞叶癫痫患者7例，术前做脑电图或24h视频脑电监测，术中在脑电监测下取颞叶大脑皮质棘波灶和海马组织，做电镜观察。结果7例患者电生理检查均可见典型痫样放电。颞叶皮质痫灶和海马可见不同程度的神经元固缩，胶质细胞变性，胶质增生，突触数量及突触结构改变，血脑屏障破坏等改变。结论影像学无异常的颞叶癫痫患者颞叶皮层痫灶和海马超微结构病理变化明显，特别是突触的变化，是导致癫痫患者脑电生理机能异常及癫痫反复自发性发作的形态学基础。

Objective To analyze EEG characteristics and observe pathological changes in temporal lobe cortexes and hippocampus in intractable temporal lobe epileptic brains in which there is no abnormality on CT or MRI examinations. Methods The electroencephalogram （EEG） and video- electroencephalogram （VEEG） were recorded in 7 cases with intractable temporal lobe epilepsy, Transmission electron microscope technique was used to investigate the changes of uhrastructure in temporal lobe cortexes and hippocampus. Results Epileptiform discharges, such as spike, polyspike complex, sharp, spike and slow wave complex were found on examinations of all 7 cases. The uhrastructure changes in spike focus of temporal lobe cortexes are similar to those in hippocampus. It was common that neurons are pycnotic and the number of them is decreased, Astrocytes are hydropic degeneration, Gliosis can be founded in some cases. The number of synapses was increased or decreased in different cases and positions, But pathological changes of them are similar, Blood-brain barriers are destroyed because of foot processes of astrocytes around capillaries are edematous, Conclusion Neuronal loss, gliosis and synaptic rearrangments which occurs in epileptic： hippocampus and in epileptic temporal lobe cortexes ion, The abnormalities is probably destroy the balance between excitatory and inhibitory associated with protopathic intractable temporal lobe epileptic seizures.