痫样放电偶极子对颞叶内侧型顽固性癫痫的定位价值

Efficiency of scalp epileptiform discharge dipole for stereotactic radiofrequency to refactory mesial temporal lobe epilepsy

目的：探讨痫样放电偶极子分析结合临床特征和其它无创检查对颞叶内侧型顽固性癫痫的定位价值。方法：对21例发作间期主要在颞区存在痴样放电且每月致残性发作1次以上的顽固性癫痫患者，结合临床特征和其它无创检查确诊为颞叶内侧型癫病并定侧后，进行机器人辅助立体定向射频热凝毁损颞叶内侧结构治疗。结果：术后12～37个月，按照Engel分级系统：Ⅰ级6例（29％，其中Ⅰa级5例，Ⅰd级1例），Ⅱb级3例（14％），Ⅳa级4例（19％），Ⅳb级7例（30％），Ⅳc级1例（5％）。术后患者的神经功能均无明显下降。结论：机器人辅助立体定向系统射频热凝毁损术安全、有效、方便、快捷，部分颞叶内侧型顽固性癫痫患者对立体定向射频热凝治疗反应良好。

Objective：To investigate the efficiency of scalp epileptiform discharge dipole,ictal character and other non-ivasive tests for stereotactic radiofrequency to refactory mesial temporgllobe epilepsy by robot assistant frameless stereotaxy. Methods： Twenty-one patients with interictal epileptiform discharge in the temporal area located in mesial temporal lobe by spike-sharp dipole were diagnosed as the cases with mesial temporal lobe epilepsy with ictal character by epileptiform discharge dipole analysis and other non-ivasive tests. All the patients had disabling seizure at least once per month,and were refactory to antiepileptic drug. They all accepted transfrontal mesial temporal lobe radiofrequency thermocoagulation performed by robot assistant frameless system. Results：The postoperative outcomes were evaluated according to Engel classification; 6（29%） patients achieved Engel class Ⅰ （including 5 Ⅰ a, 1 Ⅰ d）, 3 （14%） Engel elass Ⅱ b, 4（19%） Engel class Ⅳa,7（30%） Engel class Ⅳb,and 1（5%） Engel Ⅳc. No one had permanently functional disability. Conclusion：Robot assistant frameless stereotaxy for radiofrequency thermocoagulation is safe,effective,convenient and swift. Some of patients with mesial temporal lobe epilepsy can be cured by radiofrequeney thermocoagulation and neural stem cells.