皮层热凝治疗功能区局灶性癫痫的实验研究

Cortex thermocoagulation for control of experimental epileptogenic foci located at functional area.

目的 探讨皮层热凝治疗功能区局灶型癫痫的安全性及有效性。方法 1 .取正常家猫热凝后不同时间的大脑运动区皮层标本 ,观察毁损部位组织的病理改变与超微结构改变 ,运动区功能是否受到影响。 2 .建立家猫运动区青霉素局灶性癫痫模型 ,观察家猫热凝后癫痫发作的控制情况及皮层脑电图变化。结果 1 .行为学观察 :在热凝功率为 4U(1U =5 .8W) ,热凝持续时间 1秒 (4U/ 1S)及 3U/ 2S的家猫中 ,无偏瘫及行走不稳 ,在 4U/ 2S、5U/ 1S、5U/ 2S的家猫中 ,术后有偏瘫及行走不稳。 2 .显微镜下观察 :主要改变为两镊尖之间的一弧行带 ,“即刻标本中”神经细胞呈现缺血性改变。 7天以后的标本中则为弧形带内胶质增生。皮层热凝深度随着热凝的功率和持续时间的改变而变化。 3 .超微结构观察 :神经细胞肿胀、固缩 ,甚至出现胞浆胞核的溶解。树突肿胀、线粒体及神经微丝消失。轴突髓鞘苍白、断裂 ,有脱髓鞘现象。 4 .癫痫控制情况 :在 4U/ 1S组的热凝 ,能有效地控制急性局灶性癫痫。结论 适当功率的皮层热凝可有效地破坏水平纤维 ,从而控制癫痫发作 ,并且能较少地影响皮层的主要功能 ,对于功能区局灶性癫痫的外科治疗 。

Objective To investigate the safety and effectiveness of cortex thermocoagulation for control of epileptogenic foci located at functional area.Methods 1.The motor cortex in cats were thermocoagulated at different power,duration and interval.The histomophology and ultrastructure of the lesion and changes of motor function after thermocoagulation were reviewed.2.Cat epilepsy model was established by injection of penicillin in the motor cortex.Thermocoagulation were then used to control of epilepsy,behavioral and electrocorticographic changes were recorded.Results 1.Behavior changes:No hemiplegia and unstable gait were observed in cats that were thermocoagulated at 4U/1S and 3U/2S.Hemoplegia and unstable gait took place in cats that were thermocoagulated at 4U/2S,5U/1S and 5U/2S.2.Microscopic findings:The major histomophological change was an arc band between two forceps apex.The neurocytes in the arc band showed ischemic changes in immediate specimens,while gliosis in the specimens over seven days under microscope.The depth of lesion correlated well with the changes of power and duration of thermocoagulation.3.Ultrastructure:Swelling neurocytes,pyknotic neurocytes,lysis of cytoplasma and nucleolus were noted.Dendrites were swelling,in which mitochondrion and neurofilament disappeared.Pallor myeline,ruptured myeline and myelinoclasis were usually observed.4.Seizure control:Acute focal epilepsy could be effectively controlled when the thermocoagulation power and duration is 4U/1S.Conclusion Seizures could be effectively controlled through disrupting the horizontal fiber with cortex thermocoagulation at proper power and duration,and minimal neurological function was impaired.Therefore,we can offer a selective surgical technique for the treatment of focal epilepsy arising from the functional cortex.