儿童非病灶性癫痫的临床研究

Surgical management of non - lesional epilepsy in children

目的 对儿童非病灶性癫痫致痫灶功能定位、手术方式、手术疗效和手术前后认知功能改变的情况进行研究.方法 对21例经外科治疗的非病灶性癫痫患儿的术前定位、手术疗效和手术前后认知功能的改变进行回顾性分析,并以随机选择的20例健康学龄期儿童作为对照组.结果 21例患者中,手术疗效按Engel标准随访1年后,Ⅰ级13例,Ⅱ级4例,Ⅲ级3例,Ⅳ级1例.手术前后事件相关电位和学习障碍筛查量表结果显示术前组与对照组、术后组P300潜伏期差异均有统计学意义.结论 术前联合视频脑电图（VEEG）、fMRI、单光子发射断层扫描（SPECT）对致痫灶进行功能定位,结合其临床特点采用不同的手术治疗方式,加上术中使用皮层电极监测,是治疗儿童非病灶性癫痫的有效途径,能很好地改善患儿的认知功能障碍.

Objective To explore the identification of the localization of non - lesional epilepsy in children,surgical methods,surgical results and indicators of cognitive function before and after surgery.Method Localization and surgical results of 21 cases received surgical treatment and changes in cognitive function before and after surgery were reviewed,retrospectively,and randomly selected 20 normal school - age children as a control group.Results According to Engel scale,the results after follow - up for one year are 13 cases of Ⅰ grade,4 cases of Ⅱ grade,3 cases of Ⅲ grade and 1 case of Ⅳ grade.The results of ERPS and PRS shown that there was a significant difference between the groups（ pre -operation group vs.post - operation group and control group）.Conclusions It is an effective way to select appropriate surgical methods to NLE based on epileptic focus located by VEEG,fMRI,SPECT,clinical characteristics and using cortex electrodes EEG during operation.It can greatly improve children＇s cognitive dysfunction.