额叶癫痫简单运动症状和复杂运动症状临床特点及癫痫传播网络的研究

Study on clinical characteristics and semiology propagation network between simple motor symptoms and complex motor symptoms of frontal lobe epilepsy

目的探讨额叶癫痫简单运动症状和复杂运动症状的临床特点及癫痫症状学网络的意义。方法回顾性分析北京天坛医院功能神经外科和北京丰台医院神经外科2015年1月—2017年12月收治的额叶癫痫患者的临床资料。所有患者病理诊断均为局灶性皮质发育不良。首先进行症状学分组,而后对比两组患者的临床特点;并用PET-CT的定量化分析对比两组患者的症状学网络。结果最终纳入患者51例,男女比例为31∶20,平均年龄为(17.1±9.6)岁,平均病程为(10.0±7.7)年。不同症状学患者临床资料之间比较,差异均无统计学意义。简单运动组和复杂运动组的症状学网络有显著差异。在外侧面,简单运动组低代谢范围更加广泛,差异脑区出现于额上沟后段周围皮质、中央沟周围皮质以及上环岛沟后部。在内侧面,简单运动组低代谢范围更广,复杂运动组低代谢范围局限,后者更多累及前扣带回。两组患者低代谢均涉及基底节和脑干,且双侧受累。结论额叶癫痫的症状学网络不同;探索症状学网络,有利于设计颅内电极。额叶癫痫的皮层下网络以及双侧网络还需要进一步研究。

Objective To investigate the differences in clinical characteristics and the epilepsy symptomatology network between simple motor symptoms and complex motor symptoms in frontal lobe epilepsy.Methods The clinical data of patients diagnosed by frontal lobe epilepsy admitted in department of functional neurosurgery,Beijing Tiantan Hospital and department of neurosurgery,Beijing Fengtai Hospital from January 2015 to December 2017 were analyzed retrospectively.The pathological findings of all patients were focal cortical dysplasia.First,the patients were classified based on the symptomatology,and then the clinical characteristics of the two groups were compared.The symptomatology networks of the two groups were compared by quantitative analysis of PET-CT.Results 51 patients were finally included,with a male-female ratio of 31∶20,average age of(17.1±9.6)years,and average seizure duration of(7.0±0.7)years.There was no statistical difference the clinical data of different groups.Differences were revealed in the symptomatology network between the simple motor group and the complex motor group.On the lateral surface,the hypo-metabolism area of the simple motor group was more extensive.There was a group level of differences located in the posterior part of the superior frontal sulcus,central sulcus area,and the posterior part of the superior insular sulcus.On the mesial surface,more areas of the hypo-metabolism in the simple motor group were found,while the hypo-metabolism regions in the complex motor group were limited.Differences were located within the anterior part of the medial frontal lobe,such as the anterior cingulate gyrus.Other hypo-metabolism areas in these groups involved basal ganglia,brainstem,and the contralateral brain.Conclusion There are different symptomatology networks in frontal epilepsy.To explore this kind of network is beneficial to the design of intracranial electrode.Subcortical network and contralateral network of frontal epilepsy need further study.