神经影像学与长程VEEG 对脑结构异常所致症状性癫癎的应用价值

ANALYSIS OF NEUROIMAGING AND VEEG CHARACTERISTICS IN SYMPTOMATIC EPILEPSY CAUSED BY ABNORMALITY OF CEREBRAL STRUCTURES

目的:探讨视频脑电图与神经影像学检查在脑结构异常所致症状性癫癎中的应用价值。方法:回顾分析经临床诊断明确的脑结构异常所致症状性癫癎45例患者,探讨其神经影像学及脑电图的特点,并分析其相关性。结果:45例患者中胶质瘤12例,以星型胶质细胞瘤为主,脑膜瘤2例,动静脉畸形(AVM)4例,蛛网膜囊肿6例,脑囊虫3例,脑软化7例,海马硬化4例,脑脓肿3例,钙化4例。以上病例均经手术病检证实。VEEG有癎样放电者38例,非特异性异常3例,脑电图正常者4例。34例(75.6%)患者病理灶与致癎灶一致,病理灶与致癎灶相反者2例(4.4%),另有2例(4.4%)双侧致癎灶的患者神经影像学却为单侧病灶。结论:在症状性癫癎患者致癎灶的定位中VEEG可使大部分患者获得致癎灶的定位信息;神经影像学对症状性癫癎的病理灶定位有重要意义;VEEG和神经影像学检查相结合可提高癫癎患者致癎灶定位的准确性。

Objective： To explore the value applied of VEEG and neuroimaging in the symptomatic epilepsy caused by abnormality of cerebral structure. Methods： The neuroimaging and VEEG feature were respectively analyzed in 45 patients with symptomatic, epilepsy caused by abnormality of cerebral structures diagnosed clinically. Results： The results of neuroimaging showed that there were 20 cases of cerebral gliomas, mainly star-shaped glioblastoma, 2 cases of meningiomas, 4 cases of cerebral arteriovenous malformation （ AVM ） , 6 cases of araehnoid cyst, 3 cases of cerebral cysticereosis, 7 cases of cerebral malacia, 4 cases of hippoeampus sclerosis, 3 cases of cerebral abscess, 4 cases of cerebral calcification in all 45 patients. The cases were confirmed by surgery and obtain the pathological findings. VEEG show that epileptiform discharge were in 38 cases, non-specific abnormality were in 3 cases and normal VEEG were in 4 cases. Analysis of VEEG and imaging found in 34 patients epileptogenic focus were coincident with pathological focus and the concordance rate was 75.6%. In 2 patients, epileptogenic focus were in contrast to pathological focus, and 2 cases of bilateral focus showed unilateral focus by neuroimaging, the inconsistent rate was 4.4%. Conclusion： Most patients with symptomatic epilepsy can get lesion location information about epileptogenic focus by analyzing of VEEG. Neuroimaging play an important role in finding the pathologic locus in most patients with symptomatic epilepsy. The location information of epileptogenic focus can be more accurate by analyzing both of the VEEG and neuroimaging.