非下丘脑性发笑性癫痫发作的定位定侧分析

Analysis of location and lateralization of epileptic lesion with un-hypothalamic gelastic seizure

目的分析发笑性癫痫发作患者的临床特点,以确定癫痫病灶位置,为手术治疗提供参考。方法回顾性分析本院就诊10例发笑癫痫发作患者的临床特点,包括发作的特点、影像学的特征以及手术治疗结果等。结果 10例患者均接受手术治疗,其中8例完成分期颅内电极埋置。术后8例达到EngleⅠ级缓解,1为Ⅱ级,另外1例术后发作无明显改变。结论非下丘脑病损所致发笑样癫痫发作者若不伴有情感症状出现,病灶多在额叶,并以辅助运动区为常见,伴有情感症状者多定位于颞叶。同时,发笑症状在发作过程的早期或者单独出现者定位很可能位于右侧大脑半球,反之,在晚期出现应考虑在左侧大脑半球的定位。

Objective To analyze the seizure focus by analyzing the clinical features of gelastic seizures, thus provide a possibility for surgical treatment. Methods The clinical characteristics, neuroimaging and post operative outcome of 10 patients with gelastic seizures, whom were treated in our hospital during August 2009 to October 2011 were analyzed retrospectively. Results All patients received surgery, 8 of which received cortical implantation of subdural electrodes. 8 patients were Engle I, 1 patient was Engle II, and 1 patient had no changes afterwards. Conclusions If the un- hypothalamus gelastic seizures onset without emotional driven, the lesions would be found mostly in frontal lobe, especially in supplementary motor area （SMA）, whilst if it is emotional driven, the lesions probably located in temple lobe. If the laughter appears in the early period of seizures or solely, the lesion might in right hemisphere, otherwise the lesions might be found in the left hemisphere.