基于立体脑电图定位的扣带回癫痫患者电生理特征、发作症状学临床研究

Study on electrophysiological chracter and seizure symptomatology of cingulate gyrus epilepsy comfirmed by stereoelectroencephalogram

目的探讨扣带回癫痫的电生理特征、发作症状学及发作传播模式。方法回顾性分析2015年3月—2022年6月在兰州大学第二医院功能神经外科已被立体脑电图(SEEG)证实,手术后效果良好的10例扣带回癫痫患者,分别分析其电生理特征,发作症状及相应的传播模式。结果4例前扣带回癫痫、2例中扣带回癫痫头皮脑电图能为致痫灶定侧定位提供有价值的信息;4例后扣带回癫痫头皮脑电图难以提供较为有意义的定侧定位价值,且往往容易被误导,因此10例患者均行SEEG评估,明确致痫灶。前扣带回癫痫主要表现为带有恐惧的复杂运动症状;中扣带回癫痫表现为目标导向的运动行为及强直性姿势;后扣带回癫痫为伪颞叶症状。前扣带回主要累及情绪网络;中扣带回主要累及运动前区及辅助运动区等运动网络;后扣带回主要传播至颞叶及顶下小叶引起颞叶症状。结论扣带回癫痫虽然临床症状多变、定位和诊断困难,但仍有一定的规律可循。熟悉扣带回不同分区及功能连接是正确诊断及定位该区癫痫的前提。在扣带回癫痫的诊断中,SEEG对其定位具有重要作用。

Objective To investigate the electrophysiological character,seizure symptomatology and seizure transmission mode of cingulate gyrus epilepsy.Methods 10 patients with cingulate gyrus epilepsy confirmed by stereoelectroencephalography(SEEG)and had good postoperative outcomes in Department of Neurosurgery,the Second Hospital of Lanzhou University from March 2015 to June 2022 were analyzed retrospectively,and their electrophysiological character,seizure symptoms and corresponding propagation patterns were analyzed separately.Results Scalp electroencephalography in 4 cases of anterior cingulate gyrus epilepsy and 2 of middle cingulate gyrus epilepsy could provide valuable information for lateral localization of epileptic foci.The scalp electroencephalogram of 4 cases of posterior cingulate gyrus epilepsy was difficult to provide meaningful lateral localization value and was often misleading.Therefore,10 patients underwent SEEG evaluation,which could clearly identify the epileptic focus.Anterior cingulate gyrus epilepsy was mainly characterized by complex motor symptoms with fear.Middle cingulate gyrus epilepsy manifested as goal-directed motor behavior and rigidity posture.Epilepsy in the posterior cingulate gyrus was a pseudo temporal lobe symptom.The anterior cingulate gyrus mainly involved emotional networks.The middle cingulate gyrus mainly involved the pre-motor area and auxiliary motor area in the motor network.The posterior cingulate gyrus mainly spread to the temporal lobe and inferior parietal lobules,causing temporal lobe symptoms.Conclusions Although cingulate epilepsy has variable clinical symptoms and is difficult to locate and diagnose,there is still a certain pattern to follow.Familiarity with functional connectivity of different subdivisions of the cingulate gyrus is a prerequisite for the correct diagnosis and location of epilepsy in this region.In the diagnosis of cingulate epilepsy,SEEG plays an important role in its location.