视频脑电图结合MRI检查对药物难治性癫痫诊断的价值

Clinical Diagnosis Value of Video-electroencephalography and MRI on Pharmacal Intractable Epilepsy

目的探讨用视频脑电图和MRI诊断药物难治性癫痫的临床价值。方法收集2006年12月2010年5月间经手术和病理证实的药物难治性癫痫患者38例。其中,海马硬化25例,颞叶萎缩伴脑发育不良2例,脑灰质移位及巨脑回4例,血管畸形3例,胶质瘤2例,脑内囊肿1例,外伤性癫痫1例。用视频脑电图监测癫痫发作期及发作间期痫样放电的来源部位及脑电活动特点,用MRI扫描显示痫灶区的表现特征,并与手术、病理改变对照,进行回顾性分析。结果视频脑电图对癫痫发作期的致痫灶来源定位准确率为100%(38/38),发作间期定位准确率为53%(20/38)。MRI对发作间期的致痫灶及相关病变定位诊断准确率为89%(34/38),病变定性准确率为79%(30/38)。结论视频脑电图和MRI检查有机结合,对药物难治性癫痫,能更有效检出致痫灶的部位及性质,为药物难治性癫痫患者的手术治疗,提供重要信息。

Objective To study the clinical diagnosis value of video-electroencephalography （EEG） and MRI on pharmacal intractable epilepsy. Methods From December 2006 to May 2010, 38 cases of pharmacal intractable epilepsy were confirmed through operation and pathologic examination. Among them, there were 25 cases of hippocampal sclerosis, 2 cases of temporal lobe atrophy combined with brain dysplasia, 4 cases of heterotopic gray matter and macrogyria, 3 cases of vascular malformation, 2 cases of glioma, 1 case of cyst in brain, and 1 case of traumatic epilepsy. Video-EEG was applied to monitor the source of epileptoid discharge and the features of brain electrical activity during and between the occurrences of epilepsy. MRI was used to detect the manifestation characteristics of the epilepsy focus, and retrospective analysis was done to compare these findings with operational and pathological results. Results The accuracy rate of Video-EEG in locating the epilepsy focus was 100% （38/38） during the occurrence of epilepsy, and 53% （20/38） between the occurrences of epilepsy. The accuracy rate of MRI in diagnosing the epilepsy focus and relevant abnormalities during the occurrence of epilepsy was 890/00 （34/38）, and 79% （30/38） in characterizing the abnormalities. Conclusion Video-EEG combined with MRI examination is effective in locating and characterizing the epilepsy focus, which can provide more useful information for the surgery in treating pharmacal intractable epilepsy.