顽固性癫病人的术前综合评估(附40例报告)

Presurgical evaluation of intractable epilepsy: report of 40 cases

目的探讨常规脑电图(REEG)、视频脑电图(VEEG)、MRI、SPECT检查对癫病人术前综合评估致灶定位的意义。方法对40例顽固性癫病人进行REEG、VEEG、MRI及SPECT检查,其中32例行手术治疗,术中行皮质电极(ECoG)和深部电极监测,同时对REEG、VEEG、MRI、SPECT定位致灶的情况进行对比研究。结果REEG异常40例,局灶棘波17例(42.5%);VEEG异常40例,局灶棘波35例(87.5%),两组局灶棘波检出率有显著性差异(P <0.01)。SPECT异常32例(80%),MRI异常31例(77.5%)。在32例手术病人中,VEEG与ECoG病灶一致者30例(93.7%),MRI与ECoG一致者27例(84.3%)。结论VEEG、MRI、EEG、SPECT检查结合临床表现,对顽固性癫病人术前致灶的定位和指导手术治疗有较大的应用价值。

Objective To discuss the significance of routing-EEG (REEG), Video-EEG (VEEG), MRI and SPECT in the diagnosis of intractable epilepsy and in the evaluation of presurgical epileptogenic zone. Methods REEG, VEEG, MRI and SPECT were measured in 40 patients with intractable epilepsy, meanwhile the results were compared each other. 32 patients were operated for epilepsy. ECoG was used to confirm the epileptogenic zone. Results The abnormity in REEG, VEEG, MRI and SPECT was 40 (100%), 40 (100%), 31 (77.5%) and 32 (80%) respectively, the focal spike in REEG and VEEG was 17 (42.5%) and 35 (87.5%) respectively. There was a significant difference between REEG and VEEG (P<0.01). Of 32 patients with surgical treatment, seizure localizations by ECoG were consistent with those by VEEG in 30 cases (93.7%), by MRI in 27 cases (84.3%). Conclusion The presurgical combinating measurement by EEG, SPECT and MRI, especially VEEG shows a more important value to localize the epileptogenic zone and to direct surgical treatment.