273例颞叶癫痫临床分析

Clinical Analysis of 273 Cases of Temporal Lobe Epilepsy

目的对273例颞叶癫痫患者的脑电图特征、影像学特点及服用抗癫痫药物的疗效进行分析总结，为临床颞叶癫痫的诊疗提供参考。方法收集2013年1月～2014年12月诊断为颞叶癫痫患者的临床资料进行临床相关因素分析并对抗癫痫药物疗效进行评价。结果273例颞叶癫痫患者中90．5％的患者长程视频脑电图出现异常，睡眠期痫样放电明显高于清醒期，影像学提示异常者166例，占全部患者的的60．8％。海马硬化或变性、颞叶蛛网膜囊肿、颞叶软化灶位居前3位，19—39岁为发病高峰年龄段，单药有效率在50％以上者占92．7％，联合用药有效率50％以上者占87．8％，两种药物治疗方式有效率经x^2检验比较，差异无统计学意义（P〉0．05）。结论颞叶癫痫以复杂部分性发作多见，海马硬化、颞叶软化灶、蛛网膜囊肿等为常见病因，90．5％的患者长程视频脑电图提示异常为临床诊断提供了重要的价值。两种药物治疗方式疗效差异无统计学意义，药物治疗仍是颞叶癫痫的主要治疗方法，奥卡西平、卡马西平、左乙拉西坦、丙戊酸等新型抗癫痫药物对颞叶癫痫疗效显著。

Objective To summary the EEG characteristics,imaging features and the efficacy of antiepileptic drugs of 273 cases of TLE patients,providing reference for clinical diagnosis and treatment of temporal lobe epilepsy. Methods We collected the clinical datas from January 2013 to December 2014 in our hospital which analyzed the clinically relevant factors and evaluate the efficacy of antiepileptic drugs. Results 90.5% of 273 patients with TLE had abnormalities in long - term video EEG. Sleep epileptiform discharges was signifi- cantly higher than awake period. There were 166 cases with abnormal imaging, accounting for 60.8% of all patients. Hippocampal sclerosis or degeneration,temporal lobe arachnoid cyst,temporal lobe encephalomalacia were the three in the top. 19 to 39 years old was the peak onset age. The efficiency of single drug above 50% accounted for 92.7% ,while the two drugs combination above 50% accounted for 87.8%. Treatment efficiency of two ways was compared by X2 test, and there was no obvious statistical significance （ P 〉 0. 05 ）. Conclusion Temporal lobe epilepsy is more common with complex partial seizures. Hippocampal sclerosis,temporal lobe encephalomala- cia, arachnoid cyst were the common causes. 90.5% patients had abnormalities in longterm video EEG,which provided important value for clinical diagnosis. No significant difference between the two ways of therapeutics. Drug treatment was still the main method of temporal lobe epilepsy. The new generation of antiepileptic drugs such as oxcarbazepine, carbamazepine,levetiracetam and sodium valproate had a good effect on temporal lobe epilepsy.