颞-顶-枕结合区癫痫的临床特征和致痫灶定位研究

To study the clinical characteristics of epilepsy and the lateralition of epileptogenic zone in the tempor-parietal-occipital junction

目的初步探讨颞-顶-枕结合区(Tempor-parietal-occipital junction,TPOJ)癫痫的临床电生理、发作症状学、多模态影像特征和致痫灶定位。方法回顾2015年3月—2018年8月兰州大学第二医院收治的6例经分析已被证实为TPOJ癫痫患者的发作症状学、头颅核磁共振成像(MRI)及正电子发射计算机断层显像(PETCT)及两者融合的表现、长程头皮视频脑电图(VEEG)监测结果,分析其在致痫灶定位中的价值,并探讨基于立体定向脑电图(SEEG)多模态评估在定位致痫灶中的作用。结果发作首发症状:6例患者中2例为复杂视幻觉先兆症;3例为头眼偏转(2例为致痫灶对侧,1例为同侧);1例为过度运动。头皮EEG示:间歇期癫痫样放电位均为多脑区性,但能定侧;发作期脑电4例为弥漫性放电,无侧向性,2例能定侧(1例为一侧半球起始,1例为一侧后头部起始)。影像学表现:2例MRI为阴性,2例外伤后软化灶,2例局灶性皮质发育不良(FCD);MRI和PET-CT融合后均能发现包括TPOJ的较大范围低代谢区。6例患者均行立体定向电极植入,植入后脑电监测均能明确致痫灶。结论对于TPOJ区癫痫,发作起始期先兆、多模态影像表现可为定位致痫灶诊断提供重要线索;头皮EEG和除先兆外的首发症状仅能提供参考线索;基于SEEG的多模态评估能精准定位发作起始区。

Objective To explore the clinical electrophysiology, seizure symptomatology, multimodal imaging characteristics and epileptogenic zone location of the temporal-parietal-occipital junction(TPOJ) epilepsy. Methods The seizure symptomatology, head MRI, PET-CT and their fusion manifestations, long-range scalp video EEG monitoring results of 6 cases of TPOJ epilepsy patients from March 2015 to August 2018 were analyzed retrospectively in the Second Hospital of Lanzhou University, and the value of localization of epileptogenic zone was analyzed, and the role of multimodal evaluation based on SEEG in localization of epileptogenic zone was discussed. Results The first symptoms: 2 of 6 patients were complicated visual hallucination;3 were head eye deflection(2 were opposite to epileptogenic focus, 1 was ipsilateral);1 was excessive movement. EEG of scalp: the epileptogenic potentials in intermittent period were all multi-brain regions, but could be lateralized;in seizure period, the electroencephalogram was diffuse in 4 cases, without lateralization, and could be lateralized in 2 cases(1 case was the beginning of one hemisphere, 1 case was the beginning of one posterior head). Imaging findings: MRI was negative in 2 cases, post-traumatic soft focus in 2 cases, and FCD in 2 cases;after fusion of MRI and PET-CT, low metabolic areas in a large area including TPOJ could be found. Six patients were implanted with stereotactic electrodes, and the epileptogenic focus could be identified by EEG monitoring after implantation. Conclusion For TPOJ epilepsy, the manifestations of premonitory and multimodal images at the onset of seizure can provide important clues for the lateralition of epileptogenic zone;scalp EEG and the first symptoms except premonitory can only provide reference clues;multimodal evaluation based on stereoelectroencephalogram can accurately locate the onset of seizure.