顽固性癫痫病人术前综合评估在致痫灶定位中的应用

Application of presurgical combined evaluation of intractable epilepsy in localizing epileptogenic focus

目的 探讨常规脑电图 (REEG)、视频脑电图 (VEEG)、MRI、SPECT检查对癫痫病的诊断及术前综合评估在致痫灶定位中的意义。方法 对 6 8例顽固性癫痫病人行REEG、VEEG、MRI及SPECT检查 ,对 4 4例顽固性癫痫病人术中行皮层电极 (ECoG)和深部电极监测 ,同时对REEG、VEEG、MRI和SPECT用于癫痫病人的诊断和致痫灶的定位价值进行对比研究。结果 6 8例癫痫患者中REEG局灶棘波检出 30例 (4 1.1% ) ,VEEG局灶棘波检出 5 1例 (75 % ) ,经统计学分析局灶棘波检出率在两者之间有显著性差异 (P <0 .0 1)。SPECT异常 32例(80 % ) ,MRI异常 4 7例 (6 9.1% )。在 4 4例行癫痫手术治疗的病人中 ,ECoG与VEEG定位一致 39例 (88.7% ) ,与MRI异常部位一致 33例 (75 % ) ,1例VEEG异常部位与MRI不一致的病例 ,经ECoG证实致痫灶为VEEG异常部位。结论 VEEG对于癫痫的诊断及致痫灶的定位有相当重要的临床价值 ,优于REEG和MRI。通过临床表现、影像学、功能性检查尤其是VEEG联合检查 。

Objective To explore the significance of routing-EEG(REEG),VEEG,MRI and SPECT in diagnosis of intractable epilepsy and evaluation of presurgical epileptogenic focus.Methods 68 patients with intractable epilepsy were checked by REEG,VEEG,MRI and SPECT,their results were compared with each other.44 patients of them were operated for epilepsy,during the surgery ECoG was further employed to confirm the epileptogenic focus.Results In the 68 patients with intractable epilepsy,the detection rate of epileptogenic focuses was 44.1%,69.1%,75%,80% by REEG,MRI,VEEG,SPECT respectively.There was a significant difference between REEG and VEEG(P<0.01).In 44 patients with surgical treatment,seizure localization by VEEG were consistent with those by ECoG about 88.7%,while were about 75% by MRI, 1 patient with different focus by VEEG and MRI was consistent with VEEG confirmed by ECoG.Conclusion VEEG can play a important role in the diagnosis of epilepsy and the localization of the epileptogenic focus,which was more excellent than others.The combined application of clinical manifestation,imaging and EEG to localizing epileptogenic focus has a more important value.