X-刀治疗顽固性癫痫的初步研究

Preliminary study of X-knife treatment for intractable epilepsy

目的观察顽固性癫痫立体定向直线加速器放射外科治疗(X-刀)的随访结果,探讨X-刀治疗顽固性癫痫的可行性。方法1999年12月～2000年10月对76例顽固性癫痫病人采用BrainScanX-刀治疗系统以EEG、MRI和PET联合定位的致痫灶为靶区进行立体定向放射外科治疗,周边剂量10～13Gy。所有病人随访8～16个月,定期比较治疗前后的EEG结果并观察疗效。结果治疗组X-刀治疗后3、6、12个月复查EEG明显改善或正常,同时发作频率明显下降。按国际抗痫联盟Wieser外科手术疗效分类法进行疗效判定,1～2级61.8%,3～4级21.1%,5～6级17.1%。结论顽固性癫痫采用中、低剂量的立体定向放射外科治疗是安全、显效的,是一种非常有前景的顽固性癫痫外科治疗的新方法。

Objective To observe the follow-up results with EEG and seizure control of the patients with intractable epilepsy treated by stereotactic linear accelerators based radiosurgery,and evaluate the value and reliability of X-knife treat-ment for intractable epilepsy.Method76patients were treated by X-knife with10-13Gy peripheral dosage and the treat-ment target was based on the epileptogenic focus mainly localized by the combination of EEG,MRI and18F-FDG PET imaging.All the patients had a follow-up period of8-16months and compared the EEG results between the presurgery and postsurgery.Result EEG results were studied in3,6,12months postoperatively and abnormal EEG was modified obviously or turned into normal after treatment.The seizure frequency also decreased postoperatively.According to Wieser's classification of operative effect accepted by International League Against Epilepsy,61.8%(47/76)was classified as grade1or2,21.1%(16/76)as grade3or4and17.1%(13/76)as grade5or6.Conclusion The treatment by stereotactic radiosrugery with medium or low dosage is safe and significantly effective for the patient with intractable epilepsy.