立体定向脑电图在MRI阴性难治性癫痫中的应用价值

Application of stereotactic-electroencephalography in MRI-negative epilepsy

目的探讨立体定向脑电图(SEEG)在治疗MRI阴性难治性癫痫患者术前评估的应用价值。方法回顾性分析解放军第九八八中心医院神经外科2018年1月—9月收治的7例MRI阴性,在SEEG指导下手术切除致痫灶患者的临床资料;采用Engel分级评估术后癫痫控制效果。结果7例患者共植入63根SEEG电极,平均每例患者植入9根电极,触点数共548个;植入顺利,未出现电极折断或移位、感染、脑脊液漏等并发症;所有患者均接受可疑致痫灶射频热凝术及随后的致痫灶切除术。术后随访12~18个月,患者的发作频率平均减少92.8%(P=0.00),其中5例患者(71.4%)发作控制达EngelⅠ级,2例(28.6%)患者发作控制达EngelⅡ级。结论SEEG监测范围广,可以准确定位MRI阴性癫痫的发作起始;在MRI阴性癫痫患者术前评估中安全可行,可以有效指引手术切除致痫区,控制癫痫发作。

Objective To explore the value of stereotactic-electroencephalography(SEEG)in preoperation of patients with refractory epilepsy with negative MRI.Methods The clinical data of 7 patients who underwent SEEG-guided surgical resection of seizure onset zones in the Affiliated The 988th Hospital of PLA from January 2018 to September 2018 were analyzed retrospectively.According to the assessment of curative effect based on the Engel standard was used to evaluate postoperative epilepsy control.Results 7 patients underwent SEEG surgeries and 63 electrodes carrying 548 contacts were implanted.There was no complication such as electrode breakage or displacement,infection,cerebrospinal fluid leakage and so on.All patients underwent radiofrequency thermocoagulation for suspected epileptic foci.The following-up from 12 to 18 months showed that the mean seizure frequency decreased 92.8%(P=0.00),among which 5 in Engel gradeⅠand 2 in gradeⅡ.Conclusions SEEG has a wide range of monitoring,which can accurately locate the origin of MRI negative seizures.It is safe and feasible in preoperative evaluation of MRI negative epilepsy and can effectively guide surgical removal of epileptic foci and control of seizures.