立体定向脑电图引导下射频热凝毁损术治疗药物难治性癫痫的有效性分析

Efficacy of SEEG-guided radiofrequency thermocoagulation in patients with medically intractable epilepsy

目的分析立体定向脑电图(SEEG)引导下射频热凝毁损术对于治疗药物难治性癫痫的有效性。方法将山东大学齐鲁医院癫痫诊疗中心2018年11月至2020年11月收治的14例药物难治性癫痫患者作为研究对象,通过SEEG明确致痫灶,对致痫灶实施SEEG引导下的射频热凝毁损术,分析其有效性及安全性。结果14例患者共植入143根电极,根据SEEG结果共热凝50根电极。14例患者热凝后随访2~25个月,平均(8.29±7.90)个月,2例(14.30%)患者术后分别随访3个月及6个月,癫痫无发作为EngelⅠ级;4例(28.57%)患者术后平均随访(3.75±0.50)个月,癫痫发作减少90%以上为EngeⅢ级;5例(35.71%)患者术后平均随访(8.00±6.32)个月,癫痫发作减少50%以上为EngelⅢ级;2例(14.30%)患者术后随访25个月癫痫发作减少不足50%,1例(7.10%)热凝后随访2个月发作基本同术前为EngelⅣ级。14例患者热凝前后发作频率差异有统计学意义(P=0.0017),且热凝后的效果随着时间的延长而减退。14例患者热凝后均未出现永久性功能损害。结论SEEG引导下的射频热凝毁损术对药物难治性癫痫是一种安全、有效的疗法,影响其有效性的因素较多,它可以有效预测切除手术疗效,对特定类型的癫痫病灶可作为治疗的主要选择。

Objective To analyze the efficacy of radiofrequency thermocoagulation(RF-TC)guided by stereoelectroencephalography(SEEG)in patients with medically intractable epilepsy.Methods A total of 14 patients treated in our hospital during Nov.2018 and Nov.2020 were enrolled.Epileptogenic zones were located with SEEG,and RF-TC was performed on the epileptogenic zones.The efficacy and safety were evaluated.Results Altogether 143 electrodes were implanted,and 50 electrodes were radiofrequency thermocoagulated according to the SEEG localization results.Patients were followed up for 2 to 25 months after treatment,with a mean of(8.29±7.90)months.Two cases(14.30%)were followed up for 3 and 6 months respectively,seizure-free,classified as EngelⅠ;4 cases(28.57%)were followed up with a mean of(3.75±0.50)months,and their seizures decreased by more than 90%,classified as EngelⅡ;5 cases(35.71%)were followed up for a mean of(8.00±6.32)months,and their seizures decreased by more than 50%,classified as EngelⅢ;2 cases(14.30%)were followed up for 25 months,and their seizures decreased by less than 50%;1 case(7.10%)was followed up for 2 months,and the seizure was the same as that before treatment,classified as EngelⅣ.There was statistical significance in the frequency of seizure before and after thermocoagulation in all cases(P=0.0017),and the efficacy of thermocoagulation declined with time.No permanent functional impairment was observed.Conclusion SEEG-guided radiofrequency thermocoagulation is a safe and effective treatment for medically intractable epilepsy,but there are many factors that affect its efficacy.It can effectively predict the curative effect of surgical resection and can be used as the main treatment option for specific types of epileptic lesions.