颅内电极脑电图发作前期脑电活动特点在癫发作定位中的作用

The role of characteristics of preictal brain electrical activities of intracranial electroencephalogram in epileptic seizure localization

目的分析颅内电极脑电图发作前期脑电活动特点,探讨其与不同发作起源部位及术后病理的关系,为癫定位诊断提供依据。方法回顾性分析19例症状性难治性癫病人的临床资料,根据颅内电极记录的发作起始部位不同,将病人分颞叶外癫(n=11)和颞叶癫(n=8)。分析两组发作前期脑电的放电类型以及病理结果。结果颞叶外癫病人发作前期脑电多表现为周期样节律性快活动,颞叶癫发作前期均表现为周期样多棘/棘-慢波放电。两组病人发作前期脑电活动的放电类型存在统计学差异(χ~2=40.358,P<0.01)。术后病理结果显示局灶性脑皮质发育不良(focal cortical dysplasia,FCD)不同亚型之间的发作前期脑电活动存在统计学差异(χ~2=25.050,P<0.01)。结论起源于颞叶外的癫,发作前期脑电活动多表现为周期样节律性快活动,病理分型以FCDⅡ型多见。而起源于颞叶的癫,发作前期则以周期样多棘/棘-慢波放电为主要放电表现,病理分型多见于FCDⅠ型。

Objective To analyze the characteristics of preictal brain electrical activities of intracranial electroencephalogram,investigate the relationship between the characteristics and postoperative pathological results and provide diagnostic basis for epileptic localization. Methods Clinical data of 19 patients with symptomatic intractable epilepsy were analyzed respectively, who were divided into extratemporal lobe epilepsy（n = 11） and temporal lobe epilepsy（n = 8） according to the origin of epilepsy recorded by intracranial electroencephalogram. The discharge types of preictal brain electrical activities and pathology results were analyzed in the two groups.Results The preictal brain electrical activities mostly showed the periodical rhythmic fast activities in extratemporal lobe epilepsy patients and all showed periodical multi spikes/spike-slow waves discharges in temporal lobe epilepsy patients. There were significant differences in discharges types between the two groups（χ~2= 40.358, P 0.01）. There were significant differences in characteristics of preictal brain electrical activities between the different focal cortical dysplasia（FCD） subtypes（χ~2= 25.050, P 0.01）. Conclusions The epilepsy originating from extratemporal lobe shows periodical rhythmic fast activities and FCD Ⅱ. The periodical multi spikes/spike-slow waves discharges are the main type in epilepsy originating from temporal lobe and the FCD Ⅰ is the main pathological type.