艾滋病相关性颅内疾病继发癫痫的临床治疗

Clinical treatment of epilepsy caused by AIDS-related encephalopathy

目的 探讨艾滋病相关性颅内疾病继发癫痫的临床特点、诊疗方法及其手术治疗的效果.方法 回顾性纳入2012年6月至2018年1月首都医科大学附属北京地坛医院神经外科收治的12例艾滋病相关性颅内疾病继发癫痫患者,分析其发病特点、致病因素、诊疗方法以及手术对此类癫痫的疗效.12例患者中,颅内淋巴瘤4例、颅内结核瘤4例、隐球菌脑膜炎合并颅内压增高2例、弓形虫脑病2例.10例颅内占位性病变患者行病变切除术,其中2例合并脑积水的患者同时行脑室-腹腔分流术.12例患者术前、术后均接受高效抗反转录病毒治疗以及其他药物治疗.采用Engel分级评估患者的癫痫预后.结果 1例于术后第6天因脑水肿死于脑疝,其余11例患者术后随访6个月至2年,其中Engel分级为Ⅰ级7例,Ⅱ级3例,Ⅲ级1例.结论 艾滋病相关性颅内疾病继发癫痫的发作形式及致病因素复杂、多样,需根据患者的临床表现、实验室检查结果、影像学特点、脑电图表现并结合内科相关治疗进行综合性治疗,在充分进行术前评估并掌握适应证的情况下,手术可有效控制艾滋病相关性颅内疾病继发的癫痫.

Objective To explore the clinical characteristics, diagnostic method of epilepsy caused by acquired immunodeficiency syndrome(AIDS)-related encephalopathy and the value of surgical treatment. Methods A retrospective analysis was conducted on 12 patients with epilepsy caused by AIDS-related encephalopathy admitted to Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University from June 2012 to January 2018. Of the 12 patients, 4 had intracranial lymphoma, 4 had intracranial tuberculoma, 2 had cryptococcal meningitis with intracranial hypertension and 2 had Toxoplasma encephalopathy. Three of them had intracranial multiple occupancies. Ten patients underwent pathological excision and 2 of them with hydrocephalus underwent ventriculo-peritoneal shunt simultaneously. Twelve patients received regular drug therapy and highly active antiretroviral therapy treatment before and after operation. Results The symptoms of epilepsy were significantly improved after 6 months to 2 years of follow-up except for 1 case who died of brain edema on the 6th day after operation. Among them, Engel grade Ⅰ was achieved in 7 cases, Engel grade Ⅱ in 3, Engel grade Ⅲ in 1. Conclusions The seizure types and pathogenic factors of AIDS-related epilepsy patients are complex and diverse. Comprehensive treatment should be carried out according to clinical manifestations, laboratory examinations, imaging characteristics, electroencephalogram and medical treatment. Under the condition of full preoperative evaluation and mastery of indications, surgery could effectively control AIDS-related epilepsy.