颞叶内侧癫痫发作起始放电特征及手术疗效

Characteristics of seizures onset discharges and surgical outcome in patients with mesial temporal lobe epilepsy

目的探讨颞叶内侧癫痫发作起始放电模式、高频振荡及其手术疗效。方法回顾性纳入清华大学玉泉医院癫痫中心2014年1月至2015年12月收治的12例难治性癫痫患者，采用立体定向电极植入术均定位为颞叶内侧癫痫，根据癫痫发作起始放电模式将患者分为超同步化放电（HYP）组和低电压快节律（LVF）组。11例患者行选择性海马杏仁核切除术，1例行标准前颞叶切除术。术后随访，依据Engel疗效分级标准进行评估。结果12例患者共植入电极139根，平均（11.6±0.7）根；共累及触点1 705个，平均（142.1±9.8）个；共记录60次临床发作，以HYP发作起始的7例，以LVF起始4例，以多棘波起始1例。与HYP组比较，LVF组患者发作起始累及触点多（分别为23个和28个，P〈0.05），早期扩散快[早期扩散时间分别为（11.2±2.3）s和（7.1±1.0）s，P〈0.05]。两组患者在发作起始前均存在高频振荡。术后随访12～24个月，平均（14.7±3.5）个月，HYP组患者均无发作，Engel评级为Ⅰ级；LVF组中，1例大发作2次、小发作2～3次/月，1例大发作1～2次/月，Engel评级为Ⅲ级，另2例患者无发作。HYP组患者的术后疗效优于LVF组（χ2＝4.278，P〈0.05）。结论颞叶内侧癫痫发作起始放电模式主要为HYP和LVF，以HYP发作起始的患者手术疗效更好，且HYP和LVF发作起始前出现高频振荡，可作为电生理依据并指导临床。

Objective To explore the seizure originating pattern, high-frequency activity and surgical outcome of mesial temporal lobe epilepsy. Methods A total of 12 patients with intractable epilepsy were retrospectively enrolled in this study, who were admitted to Epilepsy Center of Ynquan Hospital,Tsinghua University, and underwent mesial temporal lobectomy from January 2014 to December 2015. Stereotactic electroencephalography （SEEG） electrodes were implanted and the diagnosis of mesial temporal lobe was confirmed. All patients were divided into hypersynchronous （HYP） group and low voltage fast （LVF） group based on the seizure onset pattern on SEEG. Selective amygdalohippocampectomy （SAH） was performed in 11 cases and standard anterior temporal lobectomy （ATL） in 1 case. Postoperative followup was performed and surgical outcomes were evaluated according to the Engel scale. Results A total of 139 electrodes were implanted in 12 patients with an average of （11.6 ±0.7） electrodes in each, which had 1 705 contacts with an average of （ 142.1 ± 9.8） contacts in each case. In total, 60 seizures were recorded, among which seizures started as HYP in 7 cases, LVF in 4 cases and poly spikes in 1 case. Compared with HYP group, LVF involved more contacts （23 vs. 28, P 〈 0.05 ） and propagated faster （ 11.2 ±2.3 s vs. 7. 1 ± 1. 0 s, P 〈 0. 05 ）. High frequency oscillation existed before both HYP and LVF occurred. Postsurgical follow-up lasted 12 - 24 months with an average of （ 14.7 ± 3.5 ） months. All patients in HYP group became seizure free and were classified as Engel Ⅰ- In LVF group, 1 case reported 2 severe attacks in total and 2 - 3 mild attacks per month ; and 1 case had 1 - 2 severe attacks per month, and both were classified as Engel Ⅲ. Postoperative outcome in HYP group was better than that in LVF group （x^2 = 4.278,P 〈 0.05 ）. Conclusions The discharge patterns of seizure onset in mesial temporal lobe epilepsy include HYP and INF. Patients with HYP as seizure onset patten1 seemed to have better surgical outcomes. High frequency activity might start prior to HYP and LVF and serve as electrophysiological evidence and clinical assistance.