颞叶癫痫的痫性放电传导和临床症状的颅内电极脑电图研究

Study of epileptic discharge propagation and semiology of temporal lobe epilepsy by intracranial EEG

目的探讨颞叶癫痫患者痫性放电的传导部位、时间和相应的临床症状变化。方法对2003年6月至2007年5月确诊为颞叶癫痫并行颅内电极埋置检查的48例患者的颅内电极脑电图和发作期症状进行回顾性分析，通过在双侧海马放置的针状电极和颞叶、额叶等放置的条状皮层电极，找出发作起源部位、早期传导部位、传导时间及发作起始症状和传导后症状。结果共记录126次临床癫痫发作，105次记录到传导部位，其中同侧颞叶内传导22次，额叶39次，顶枕叶18次，对侧海马10次，16次全脑放电。44．8％传导时间小于2．5S，55．2％传导时间超过2．5S，且有17．1％超过5S。101次发作中出现初始症状，其中82．2％为意识水平下降、自动症、恐惧等；99次记录到传导后新症状，其中出现颞叶外传导者82．2％出现抽动或强直表现。结论颞叶癫痫放电传导部位主要是同侧的额叶与颞叶内部，但也可直接到对侧海马结构，临床症状与传导位置有关，传导速度多较慢。

Objective To explore the position and interval of epileptic discharge propagation and relevant semiology for patients with temporal lobe epilepsy （ TLE ）. Method To retrospectively analyze intracanial EEG and seizure symptoms of 48 patients with TLE. Bilateral needle electrodes in hippocampus and strip subdural electrodes in aeocortex of temporal lobe, frontal lobe or parieto - occipital lobe were implanted for long - term video EEG monitoring in all cases, focus of initial ictal discharge, position and interval of epileptic discharge propagation and relevant clinical symptom were confirmed. Results 126 seizures and 105 propagations were recorded,including 22 propagations between hippocampus and neocortex of temporal lobe ,39 propagations to ipsilateral frontal lobe, 18 to parietal or occipital lobe, 10 to contralateral hippocampus and 16 cases with secondary diffuse discharge. There were 44. 8% conductive interval less than 2. 5 s, 17.1% more than 5 s. 101 seizures appeared initial symptom and 82. 2% of them are decline of conscious level,automatism or fear, also 99 new symptoms followed propagation were recorded, and 82. 2% appeared clonic and/or tonic signs when epileptoform discharge conducted to extratemporal region. Conclusions In TLE, most seizure spread to ipsilateral frontal lobe or temporal, however, ictal propagation also can occur from one hippocampus to another. Semiology was associate with conductive region, and spread velocity often was slow.