颅内电极对额叶癫癎发作症状的定位研究

Intracranial EEG findings and frontal lobe epileptic symptoms

目的：探讨额叶癫癎（FLE）各种发作期症状的可能产生部位。方法：回顾性分析2005—2007年在我中心接受颅内电极植入手术和癫癎灶切除术的FLE患者资料，Engel评分在Ⅱ级以上的18例患者，按发作的时间过程分解各次发作的症状学特征，分析同期皮层电图的放电部位，确定症状－解剖部位之间的相关性。根据颅内电极发作期放电的起始部位切除癫癎起源灶。结果：18例患者颅内V-EEG共监测到77次发作（每例1～18次）。额叶背外侧及运动区起始的发作期多数表现为棘波节律发放，但4例以躯体自动症开始的发作者显示为一侧额极的慢波活动；1例以发声开始的发作者皮层电图表现为弥漫性电压下降，而后出现一侧额极、中央前回棘波节律及双侧辅助运动区慢波，伴局部阵挛和躯体自动症。结论：颅外EEG对发作起源仅能给出初步的提示，精确定位需要应用颅内电极。早期和中期的发作症状，涉及的区域多数为解剖学的功能分区，晚期的发作症状，常涉及的是功能分区的临近部位。症状起源区和解剖学功能分区有比较高的符合率，症状学分析能够对癫癎灶定位有提示意义。

Objective：To localize the sites which originate frontal lobe epileptic （FLE） symptoms in different seizure periods. Methods： Eighteen patients with FLE diagnosed by neuroimaging and （or） extracranial V-EEG （scalp＋ sphenoid electrode） both of interval and seizure periods were implanted intracranial electrode and then under V-EEG monitoring（ECoG）. Their seizure symptoms were decomposed in seizure periods （early, middle and later）. The origin and spread area of discharge were located, then the relationship between FLE symptoms and the anatomical parts were searched. Epileptic initiation sites in seizure periods of EEG were resected. Results： Seventy-seven seizures were recorded totally （1 18 times,the average of 4.27 ± 4.24）. While seizures originated from dorsolateral prefrontal cortex and motor area, EEG were mostly spikes rhythms. Four cases beginning with hyperkinetic automatisms showed slow wave activity in one side of antinion; one case beginning with phonate showed diffuse voltage drop, then partial clonic seizures and hyperkinetic automatisms , while EEG were spikes rhythms in one side of antinion and gyrus precentralis, and slow rhythms in bilateral supplemental motor area. Conclusion： The electrocorticography monitoring with chronic intracranial electrodes may play an important role in the surgical treatment for FLE. Symptoms of early and middle periods mostly are generated from classic symptomgenic zones. Symptoms of later periods are mostly from the area close ＇to classic symptomgenic zones. It probably results for activation and generalization of peripheral zones while epileptic seizure takes place. Symptomgenic zones according to EEG and the classic functional projection mostly are coincidence,semeiology analysis is very important to localize epileptogenic zones.