VEEG对难治性非惊厥发作癫痫的诊断及致痫灶术前定位价值

Significance of video-EEG in the diagnosis of intractable non-convulsive seizure epilepsy and presurgical evaluation on the epileptogenic lesion

目的:探讨长程视频脑电图(VEEG)对非惊厥发作癫痫的诊断价值及对难治性癫痫术前定位的意义。方法:对22例难治性非惊厥发作性癫痫患者行VEEG监测,22例行头MRI检查,17例行发作间期PET-CT检查,8例行脑磁图(MEG)检查。对所有患者进行致痫灶术前定位评估后11例行手术治疗,术中皮层脑电图(ECoG)监测结果验证VEEG定位的准确性。结果:22例VEEG监测时间24～48 h,共监测到83次非惊厥发作,其中5例(22.72%)监测到既往未曾发现的发作类型。每例均记录到临床发作和相应的发作期脑电异常(2～20次),18例(69次)提示局灶起源(额叶起源6例,颞叶起源7例,额颞叶起源5例),其中12例(54次,占78.26%)发作起始区与症状产生区一致。VEEG定位的致痫灶区与头MRI有结构异常者符合率为100%,与PET-CT符合率为82.35%,与MEG符合率为100%,与11例手术治疗患者的ECoG监测结果一致(符合率100%)。结论:VEEG可提高癫痫患者非惊厥类发作的检出率,有助于癫痫的分类,比较准确地定位致痫灶,是难治性癫痫术前评估必不可少的检查。

Objective： To explore the significance of long time Video-EEG in the diagnosis of non-convulsive seizure and preoperative localization of refractory epilepsy. Methods： 22 patients with intractable non-convulsive seizure epilepsy were checked by VEEG, all of them were checked by MRI, 17 patients were checked by interictal PCT-CT, 8 patients were checked by MEG. All patients did the preoperative evaluation on epileptogenic zone, then in half of them with surgical treatment,the accuracy of epileptogenic zone was validated with intraoperative electrocorticography （ECoG）. Results： 22 patients were monitored by VEEG for 24-48 h, 83 non-convulsive seizures were observed in which unknown seizure type in past medical history was found in the 5 patients. In all patients clinically seizures and ictal discharge （2 -20 times） were watched. 18 ictal EE G prompted discharge area： frontal （ 6 ）, temporal （ 7 ）,frontal-temporal area （ 5 ）.The seizure onset zone was consistent with symptomatogenic zone in 12 patients. The coincidence rates of VEEG methods on localizing epileptogenic zone with the abnormal MRI and with MEG were 100% respectively,and with PET-CT was 82.35%.VEEG was consistent with ECoG in the 11 patients who with surgical treatment. Conclusion：VEEG can improve the detection rate of non-convulsive seizure and also has a notable value in diagnosis classification. Meanwhile, it has significance in preoperative localization of epilepsy surgery. VEEG is an essential examination on presurgical evaluation in intractable epilepsy.