立体定向脑电图在儿童药物难治性癫痫中的应用

Application of Stereo-EEG in pediatric patients with drug-resistant epilepsy

目的初步探讨立体定向脑电图（SEEG）技术在儿童药物难治性癫痫诊疗中的作用。方法回顾性分析2014年10月至2017年7月首都医科大学宣武医院神经外科收治的24例药物难治性癫痫患儿的临床资料。所有患者均行SEEG检查。8例行手术切除致痫灶，15例行SEEG引导下射频热凝治疗，1例多灶起源患儿行射频热凝联合手术切除治疗。采用Engel分级评估术后疗效。结果24例患儿共植入160根电极，每例植入2—13根电极，平均（6．7±2．4）根／例。随访时间为3～36个月，平均（13±8）个月。术后14例癫痫得到完全控制（EngelI级），包括3例行手术切除治疗和11例行射频热凝治疗的患儿；7例术后稀少发作（EngelⅡ级）；2例术后发作部分改善（EngelⅢ级）；仅1例脑炎后多灶起源的癫痫患儿经射频热凝治疗后无明显改善（EngelⅣ级）。所有病例均未发生永久性的神经功能损害。结论应用SEEG辅助确定儿童药物难治性癫痫患者癫痫灶的部位和范围，从而指导进一步的手术治疗，可获得良好的治疗效果。

Objective To explore the values of stereoelectroencephalography （SEEG） in pediatric patients with drug-resistant epilepsy. Methods The clinical data of 24 pediatric patients with drug-resistant epilepsy in whom SEEG were performed from October 2014 to July 2017 at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Eight patients underwent surgical resection and 15 underwent SEEG-guided radiofrequency- thermocoagulation （RF-TC） with the aim of ablating the epileptogenic zone （EZ）. Besides, 1 patient who showed multiple and distant onset zones underwent both resection and SEEG-guided RF-TC. The postoperative outcome was evaluated by Engel classification. Results A total of 160 （ average： 6. 7 ± 2. 4, range ： 2 - 13 ） electrodes were implanted in 24 patients. Postoperative follow-up time was 13 ± 8 months （ range ： 3 - 36 months）. The outcome of Engel class Ⅰ was reported in 14 patients （resection： 3 cases, RF-TC： 11 cases）, class Ⅱ in 7, class Ⅲ in 2 patients and class Ⅳ in 1. No permanent neurological deficit was found. Conclusion SEEG in pediatric drug-resistant patients could facilitate the exploration of EZ and its scope to guide the surgical treatment, which might have good outcomes.