立体定向脑电图引导下致痫网络射频热凝术治疗难治性癫痫的初步应用

Preliminary utility of stereoelectroencephalography (SEEG) guided radiofrequecy thermocoagulation of epileptogenic networks for refractory epilepsy

目的:探讨立体定向脑电图(SEEG)引导下作致痫网络射频热凝术治疗难治性癫痫的疗效和安全性。方法:回顾性分析2018年8-11月完成的9例SEEG引导下致痫网络热凝毁损术治疗难治性癫痫患者的临床资料。结果:9例患者共植入电极118根,平均13. 11根/人,行SEEG致痫网络热凝毁损的电极2-10根,毁损的电极靶点4-75点。9例患者中1例出现短暂性高热,1例出现新的发作形式,1例因水肿出现对侧肢体轻偏瘫,治疗后恢复正常。随访超过6个月8例患者纳入疗效评估,手术疗效采用ILAE分级标准,6例达到ILAE Ⅰ级(75%),2例达到ILAE Ⅲ级(25%),其中1例为原有发作消失,但出现新的发作形式,考虑由右侧顶盖毁损灶水肿所致。结论:SEEG引导下作热凝毁损术治疗难治性癫痫是个安全、有效的治疗选择,部分病例可以有效控制发作,提高患者生活品质,其结果可以部分预测切除性手术的疗效。

Objective: To explore the efficacy and safety of stereoel-ectroencephalography (SEEG) guided radiofrequency thermocoagulation (RFTC) for the treatment of refractory epilepsy. Methods: A total of 9 patients were recruited from August to November 2018. The clinical data of all patients with refractory epilepsy in the treatment with SEEG guided RFTC were retrospectively analyzed. Results: A total of 118 electrodes were implanted in 9 patients, with an average of 13. 11 per case. 2-10 electrodes with 4-75 contacts were thermocoagulated according to SEEG findings. One of the 9 patients developed transient hyperthermia, 1 patient developed a new type of seizure and 1 patient had transient mild hemiparesis due to edema and completely recovered afterwards. 8 patients who were followed up for more than 6 months received the evaluation of the curative effect. The outcome of the RFTC procedure was scored based on the IALE classification criteria. 6 cases out of the 8 patients reached ILAE grade Ⅰ(75%), and 2 patients were in ILAE grade III (25%) including one case free from original seizure, but with a new type of seizure. It might be related with the edema of the lesion on the right side. Conclusion: SEEG-guided RFTC is a safe and effective procedure for refractory epilepsy. It can effectively control the seizures of some patients and improve their quality of life. The RFTC outcome can partially predict the curative effect of resection surgery.