发作间期的高频振荡定位药物难治性癫痫致痫灶（附1例报告并文献复习）

High frequent oscillations on depth EEG to locate epileptogenic zone- A report and literature review of one case

目的：报道对1例药物难治性癫痫患者应用深部电极脑电图（EEG）长程监测发现的发作间期高频振荡分布及与其它辅助检查、临床症状的一致性，结合手术后疗效，分析高频振荡对药物难治性癫痫的定位价值。方法：记录患者自然安静睡眠高频振荡脑电活动5min，对比围发作期症状、影像学资料、常规神经电生理资料，分析深部电极记录的高频振荡与其它资料的一致性，根据高频振荡进行手术后的临床效果评价，并结合文献资料进行分析。结果：29岁男性患者临床发作表现提示可能为右额病灶，PET-CT示右额中回低代谢，MRI表现为双海马萎缩，头皮EEG显示右额尖慢波，颅内电极高频振荡位于双颞叶内侧和右额，自然睡眠期左侧颞叶内侧最频发且波幅高（自动检测），深部皂极EEG提示右额为起源灶（术后8h内癫痫持续状态，与惯常发作有异），主要参考发作间期高频振荡分布，进行立体定向射频热凝毁损左侧颞叶内侧后，患者术后4个月仅留先兆，不影响正常工作生活。结论：在患者安静睡眠期记录颅内电极发作间期高频振荡5min，可以显示患者的潜在致痫灶，帮助临床定位。

Objective：To report the multiple foci high frequent oscillations（HFOs） in tong term depth EEG of a patient with intractable epilepsy and review the related literature. Methods：The HFOs of the patient who was quietly sleeping were recorded, for 5 minutes The locations of HFOs, EEG, MRI and epileptic symptoms were analyzed and the operative result was assessed. Results：The complex partial sei- zures of the 29 years-old male patient probably indicated epileptonic right frontal lobe , hypometabolism foci was in the right midfrontal gyrus,bilateral hippocampal atrophy was found in MRI, right high fre- quent seizures remarkably in frontal lobe sharp-slow waves were in EEG, HFOs were in the bilateral me- sial temporal lobe and the right frontal lobe,with the left mesial temporal lobe and the onset zone was in the right frontal lobe 4 months after the stereotactic radio frequency amygdalohippocampectomy in the left mesial temporal lobe,the patient only had aura. Conclusion. HFOs in depth EEG for 5 minutes can be a- dopted to accurately locate the epileptogenie zone.