长程视频脑电图在枕叶癫痫诊断及手术定位中的应用

The application of long term video-electroencephalogram in diagnosis and localization of occipital lobe epilepsy

目的：探讨长程视频脑电（V-EEG）在枕叶癫痫（OLE）手术诊断及定位中的应用。方法：27例难治性癫痫经过带蝶骨电极的长程V—EEG监测，结合磁共振成像（MRI）、发作间期正电子发射计算机断层扫描（PET）及视力视野检测结果确定癫痫起源位置为枕叶，对该27例长程V-EEG监测结果进行回顾分析，总结OLE的长程VEEG特点。结果：癫痫起源位置的EEG定位，4例位于颞枕区、4例顶枕区、1例颞顶枕区，18例单纯枕区。OLE具有较高视觉先兆出现率，本组为21例（78％）。发作间期EEG可以具有以下特征：①正常，②慢a节律或广泛θ节律，③一侧枕区脑波被抑制，④一侧或者双侧枕区存在异常电活动，⑤病灶周围脑区存在异常电活动，⑥病灶一侧半球各导联均分布有异常电活动，⑦异常电活动主要为尖波及尖慢波。OLE发作期初期（起始）EEG具有以下特征：①一侧枕区优先优势异常放电，②一侧颞枕区优先优势异常放电，③一侧顶枕区优先优势异常放电，④半球优势异常放电，⑤无侧别优势。结论：OLE具有相应的EEG及临床发作特征，蝶骨电极长程V-EEG结合影像学以及视力视野检查结果能有效诊断OLE，为准确定位提供一定可靠依据，有效指导手术治疗。

Objective： To investigate the application of long term video-electroencephalogram （V- EEG） monitoring in diagnosis and localization of epileptogenic focus of occipital lobe epilepsy（OLE）. Methods： The results of V-EEG monitoring in 27 patients with OLE were retrospected by long term V- EEG monitoring combined with magnetic resonance imaging （MRI）, positron emission tomography （PET）, vision and visual field detection , then characteristics of OLE were summarized. Results： Epileptogenie loci of the 27 patients were located as below ： temporal-occipital lobe in 4 cases, parietal-occipital lobe in 4 cases, temporal-parietal -occipital lobes in 1 case, occipital lobe purely in 18 cases. It showed high appearance rate of aura as 77.8%（21 cases） in this group. There were several foerms of EEG in interictal period as below： （1） normal EEG, （2）slow alpha rhythm or pervasive theta rhythm, （3）inhibited brain waves on one side of occipital lobe , （4）abnormal electric activities on one side or both sides of occipital lobes, （5）abnormal electric activities in the area of focus and around it,（6）abnormal electric activities in all the electrodes on unilateral occipital lobes, Oabnormal electric activities as sharp waves and sharp slow wave complex. The characteristics of clinical seizures （onset） are as follows： （1） epileptic discharge from one side of occipital lobe showed priority and superiority,（2）epileptic discharge from one side of temporaloccipital lobe showed priority and superiority, （3）epileptic discharge from one side of parietal-occipital lobe showed priority and superioroty, （4）epileptic discharge from the half lobe with the focus showed superiority,（5）neither of both sides showed superiority. Conclusion： OLE has corresponding characteristics with EEG and seizure forms. Continual sphenoidal electrodes monitoring combined with MRI and PET,vision and visual field detection can supply credible evidance for localization of epileptogenic focus accurately and direct epilepsy surgery effectively.