颅脑结构性病变所致癫痫的伽玛刀治疗及随访研究

Follow-up study of epilepsy caused by brain structural lesions after gamma knife radiosurgery

目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。

Objective To study the method of gamma knife(γ-knife)in the treatment of epilepsy caused by brain structural lesions,and to evaluate the therapeutic effect and the significance of video electroencephalogram(VEEG)follow-up.Methods The clinical data of 60 patients with epilepsy caused by structural lesions of the brain from January 2017 to June 2021 in the Department of Gamma Knife Radiosurgery and the Department of Neurology,Daizhuang Hospital of Shandong province.The patients were divided into two groups according to whether they were treated withγ-knife or not:control group(n=30)andγ-knife group(n=30).Follow-up observation was carried out to analyze the effect ofγ-knife treatment and EEG results.Results During the follow-up period of 1-2 years,the improvement rate of epilepsy was 76.67%inγ-knife group and 36.67%in control group(P<0.05),the rate of epileptiform discharges was 30.00%inγ-knife group and 66.67%in control group,the EEG normal rate was 50%in the patients with excellent seizure control in theγ-knife group,which was significantly higher than that in the effective group(11.11%)and the ineffective group(0),the detection rate of EEG epileptiform wave in effective group(7.14%)was significantly lower than that in effective group(22.22%)and ineffective group(85.71%).During the follow-up period afterγ-knife treatment,the improvement rate of epilepsy was 63.33%in 0.5-1 year period,76.67%in>1-2 years period,80.77%in>2-3 years period and 82.61%in more than 3 years period,the detection rate of VEEG epileptiform wave was 63.33%in 0.5-1 year,30.00%in>1-2 years,23.08%in>2-3 years and 21.74%in more than 3 years.Conclusion The effect ofγ-knife treatment on intractable epilepsy caused by intracranial structural lesions is clear.Vedio-electroencephalogram is helpful for the design ofγ-knife treatment regimen,the evaluation of therapeutic effect and the guidance of post-treatment medication.