脑磁图引导下伽玛刀治疗难治性癫的疗效及其影响因素研究

Investigation of efficacy and its influence factors of magnetoencephalography guided gamma knife radiosurgery on treating refractory epilepsy

目的研究脑磁图引导下伽玛刀治疗难治性癫（RE）的效果及其影响因素。方法对40例RE患者,调查其临床资料,用脑磁图结合脑电图进行致灶定位后行伽玛刀治疗。术后观察癫发作状况,随访2~4年。按Engel癫外科疗效评定标准,达到Ⅰ级和Ⅱ级的患者为治疗有效组,Ⅳ级的患者为治疗无效组,Ⅲ级不纳入以上两组。比较治疗有效组与无效组患者的临床资料,并用多因素Logistic回归分析影响伽玛刀治疗RE效果的因素。结果本组患者在随访期末达Engel疗效标准Ⅰ级19例（47.5%）、Ⅱ级7例（17.5%）、Ⅲ级5例（12.5%）、Ⅳ级9例（22.5%）,治疗有效率为65.0%。其中1例患者在治疗后出现短暂脑水肿所致的头痛。治疗无效组患者癫发作的频率和智能障碍的比率显著高于治疗有效组,颞叶癫的比率显著低于治疗有效组（P〈0.05~0.005）。多因素Logistic回归分析显示,RE患者伴智能障碍是伽玛刀治疗效果差的影响因素（OR=1.16,95%C：I 0.49~1.89,P=0.025）,而颞叶癫是其治疗效果好的影响因素（OR=0.74,95%CI：0.21~2.55,P=0.021）。结论脑磁图引导下伽玛刀治疗RE有明显效果;伴智能障碍是伽玛刀治疗RE效果差的独立危险因素,而颞叶癫是治疗效果好的预测因素。

Objective To explore the efficacy and its influence factors of magnetoencephalography（MEG） guided gamma knife radiosurgery on treating refractory epilepsy（RE）.Methods The clinical data of 40 RE patients were collected,and the patients were treated with gamma knife radiosurgery after the localization of epileptogenic focus guided by MEG and EEG.The condition of seizures was observed after the treatment,and followed up for 2-4 years.Engel＇s classification was used to assess its efficacy.The patients who reached Engel class Ⅰ and Ⅱ were assigned to the good outcome group,class Ⅳ to the poor outcome group,and class Ⅲ were not included.The clinical data of the patients were compared between good outcome group and poor outcome group.The influence factors of therapeutic effects of gamma knife were analyzed by multivariate Logistic regression.Results At the end of the follow up,19 cases（47.5%） reached Engel class Ⅰ,7 cases（17.5%） reached Engel class Ⅱ,5 cases（12.5%） reached Engel class Ⅲ,9 cases（22.5%） reached Engel class Ⅳ.The effective rate was 65.0%.Only one patient suffered a brief headache caused by brain edema after treatment.The seizure frequency and the rate of mental retardation in poor outcome group was significantly higher,and the rate of temporal epilepsy was significantly lower than those in good outcome group（P0.05-0.005）.The multiple Logistic regression showed that mental retardation was the influence factor of poor outcome of gamma knife radiosurgery treatment（OR=1.16,95%CI： 0.49-1.89,P=0.025）,while the temporal epilepsy was the influence factor of good outcome（OR=0.74,95%CI： 0.21-2.55,P=0.021）.Conclusions Gamma knife radiosurgery guided by MEG is evidently effective therapy for RE patients.Mental retardation is an independent risk factor,while temporal epilepsy is a protective factor for the gamma knife radiosurgery efficacy of RE patients.