局限型与扩展型枕叶癫痫的临床特点及手术疗效比较

Clinical features of isolated and extended occipital lobe epilepsy and their surgical outcome comparison

目的探讨局限型（致痫灶局限于枕叶内）与扩展型（致痫灶同时涉及枕叶外的脑叶）枕叶癫痫的临床特点及不同预后．以期为临床诊疗提供帮助。方法回顾性分析北京军区总医院自2011年6月至2013年6月收治的32例枕叶癫痫手术患者的临床资料，根据病灶位置将其分为2组：局限型枕叶癫痫组（14例）、扩展型枕叶癫痫组（18例）。分析比较2组患者的基本情况、发作和定位诊断的相关数据，以及预后情况。结果（1）局限型与扩展型枕叶癫痫患者的性别、病程、发作类型、术前用药、定位诊断及手术疗效等多数临床资料差异没有统计学意义（P〉0．05）。（2）发作特征方面．扩展型枕叶癫痫患者的非视觉性先兆明显多于局限型枕叶癫痫患者，差异有统计学意义（P〈0．05）。2种类型患者主要发作类型为复杂部分性发作（31例，97％），继发全身强直阵挛发作18例（44％），且多见于扩展型枕叶癫痫。（3）定位诊断方面，脑电图、MRI等多种诊断方法对于2种类型癫痫患者的诊断效果差异无统计学意义（P〉0．05）。但行颅内电极植入后脑电图定位诊断的患者均为扩展型枕叶癫痫，提示其致痫灶定位的难度更大。（4）局限型枕叶癫痫患者中12例（86％）术后达到满意疗效，扩展型中13例（72％）达到满意疗效，差异亦没有统计学意义（P〉0.05）。结论扩展型枕叶癫痫的定位诊断难于局限型，但通过综合运用包括颅内电极脑电图在内的多种定位诊断方法，准确定位并有效切除致痫灶亦可取得较好疗效。

Objective To investigate the clinical features of isolated occipital lobe epilepsy （OLE, epileptogenic focus is confined to the occipital lobe） and extended OLE （epileptogenic focus also relates to the other lobes outside occipital lobe） to guide the clinical diagnosis and treatment. Methods A retrospective analysis was performed on the clinical data of 32 patients with OLE, admitted to our hospital from June 2011 to June 2013. And the patients were divided into 2 groups： isolated OLE （n=14） and extended OLE （n=l 8）. The basic situation, seizure and diagnosis between patients in the two groups were compared. Results There were no significant differences in most clinical data between isolated and extended OLE patients, such as gender, disease duration, seizure type, premedication, localization diagnosis and surgical outcome （P〉0.05）. However, as compared with that in isolated OLE patients, non visual aura in extended OLE patients was more common, with significant difference （P〈0.05）; complex partial seizures were noted in 31 patients （97%）; generalized tonic-clonic seizures were noted in 18 patients （44%） and most of them happened in extended OLE. Diagnostic approaches as electroencephalogram and MR imaging showed no significant difference in the diagnosis results of these two OLE （P〉0.05）. Patients underwent intracranial electrodes implanted EEG monitoring were all extended OLE ones, indicating that localization of epileptogenic focus were difficult. Satisfactory curative effect was achieved in 13 extended OLE patients （72%） and 12 isolated OLE patients （86%）. Conclusion The localization diagnosis of extended OLE is more difficult than isolated OLE; however, satisfactory curative effect can be obtained in intractable OLE through integrated using many kinds of localization diagnosis methods （including intracranial electrode EEG）, and accurate localization and effective resection ofepileptogenic focus.