立体定向脑电图引导下射频热凝毁损术治疗药物难治性癫痫

Stereotatic EEG-guided radio-frequency thermocoagulation of epileptogenic zones in the patients with refractory epilepsy

目的探讨立体定向脑电图(SEEG)引导下射频热凝毁损术治疗药物难治性癫痫的效果。方法回顾性分析2015年6月至2016年7月收治的33例药物难治性癫痫的临床资料,对视频脑电图、MRI、脑磁图和PET检查仍不能明确致痫区的病例进行SEEG记录以更好地确定致痫灶。所有病人均采用SEEG引导下射频热凝毁损术治疗,射频毁损靶点为SEEG监测下的癫痫起始区或癫痫网络中频繁放电的电极位点。结果 SEEG记录显示,33例中,5例为单电极起始(同一电极的1~3个触点),15例为单脑区/部位起始(多根电极起始,但局限于同一脑区或病灶部位),6例为相邻多脑区起始,7例为不同脑区的多部位弥漫起始区。每例病人射频毁损1~11个靶点,手术期间未观察到严重不良反应。术后随访6~15个月,4例癫痫发作停止,3例发作减少80%以上,10例减少50%~79%;8例减少10%~49%;8例较术前无明显缓解。结论 SEEG引导下射频热凝毁损术是药物难治性癫痫安全有效的治疗方法。

Objective To evaluate the curative effect of stereotactic electroencephalography （SEEG）-guided radio-frequency thermocoagulation （RF-THC） of the epileptogenic zone on refractory epilepsy. Methods The clinical data of 33 patients （19 male, 14 female; age, 4~34 years） with refractory epilepsy undergoing SEEG-guided RF-THC of the epileptogenic zones were analyzed retrospectively. SEEG were performed in order to indentify the epileptogenic zones in the patients with refractory epilepsy in whom the epileptogenic zones were not identified by video-EEG, MRI, magnetoencephalography and PET. The electrode contacts which obviously discharged （interictal frequent spikes, plus spike and ictal low-voltage fast activity） during SEEG monitoring were chosen for RF-THC lesions in all the patients. Results According to SEEG recordings, ictal discharge originated from single electrode in 5 cases, focal areas in 15 cases and more than two brain areas in 6 cases, and interictal and ictal discharge were diffused in 7 cases. No serious side effects during the RF-THC procedures were observed in all the patients. The following up from 6 to 15 months showed that there was no seizure again in 4 cases （focal epileptogenic zone） and no change in 8 cases, and seizure decreased by more than 80% in 3 cases, by 50%~79% in 10 cases, by 10%~49% in 8 cases compared with the preoperation status. Conclusions SEEG-guided RF-THC is a safe and effective method to treat the refractory epilepsy.