额叶癫痫的手术治疗

Surgical treatment for frontal lobe epilepsy

目的总结并分析顽固性额叶癫痫患者手术治疗的效果、手术方式和经验。方法回顾性分析2003年3月至2009年4月在我院接受手术治疗的116例顽固性额叶癫痫患者的临床及脑电图特征、手术方式和疗效。结果随访1～6年,平均2.6年。疗效根据Engel的标准进行评定,其中I级(癫痫发作消失)49例(42.2%);Ⅱ级(癫痫发作频率减少≥90%)36例(31.0%);Ⅲ级(癫痫发作频率减少≥75%)19例(16.4%);Ⅳ级(癫痫发作频率减少<75%或与术前相近)12例(10.3%)。本组总有效(Ⅰ、Ⅱ、Ⅲ级)率为89.7%;效果优良(Ⅰ、Ⅱ级)率为73.3%。此外,患者术前所伴有的精神和行为异常在术后多数患者有所改善。术后无严重并发症及手术死亡。结论对于顽固性额叶癫痫,准确定位原发致痫灶并采用合理的手术方式彻底处理痫灶是手术成功的关键。必要时应采用颅内埋藏电极来寻找原发致痫灶。

Objective To investigate the surgical procedures and outcomes of intractable frontal lobe epilepsy.Methods Clinical data,electroencephalographm （EEG）,surgical procedures and outcomes of 116 patients with intractable frontal lobe epilepsy between March 2003 and April 2009 were reviewed.Results All cases were followed-up from 1 year to 6 years （average 2.6 years）. Among all the patients,49 patients （42.2%） got Engel class Ⅰ outcome （free of disabling seizures）,36 patients （31.0%） got Engel class Ⅱ outcome （more than 90% decreased in their seizure frequency）,19 patients （16.4%） got Engel class Ⅲ outcome （more than 75% decreasesd in their seizure frequency）,and 12 patients （10.3%） got Engel class Ⅳ outcome （less than 75% decreased in their seizure frequency or no improvement）. The effective rate was 89.7% and the ratio of excellent outcome was 73.3%. Furthermore,improvement of cognitive abilities,behavior,and quality of life was reported in most cases. There was no death and serious complication.Conclusion Accurate location of primary seizure foci and complete resection of all seizure foci by suitable surgical procedures are crucial in the surgery of frontal lobe epilepsy. In some cases it is necessary to locate seizure foci by intracranial EEG.