地西泮颈动脉内注射对难治性癫痫痫灶定侧的意义

Significance of lateral focus of intra-carotid arterial diazepam injection for intractable epilepsy

目的 探讨地西泮颈动脉内注射对难治性癫痫的痫灶定侧的意义。方法 对 2 0例两侧同步性痫样放电的难治性癫痫患者在脑电图 (EEG)监测下进行地西泮颈动脉内注射 ,观察注药后痫样放电受抑制情况来确定痫灶侧。结果 痫灶侧地西泮颈动脉内注射后两侧同步性痫样放电消失 16例 (80 % ) ,痫灶对侧地西泮颈动脉内注射后则注药侧痫样放电消失 ,而痫灶侧痫样放电仍然存在 4例 (2 0 % )。 2 0例患者中 ,有 12例经手术脑皮质电图 (ECoG)、脑深部电图 (DEEG)证实定侧、定位准确 ,手术及伽玛刀治疗后随访 1 0～ 6 5年 ,临床发作及脑电图检查痫样放电消失15例 (75 % ) ,好转 5例 (2 5 % )。结论 地西泮颈动脉内注射对难治性癫痫患者两侧同步性痫样放电的术前痫灶定侧有重要的临床应用价值。

Objective To explore the significance of lateral focus of intra-carotid arterial diazepam injection for intractable epilepsy.Methods Intra-carotid arterial diazepam injection test was done in 20 patients with intractable epilepsy which manifested bilateral synchronous epileptiform discharge under EEG-monitor to judge epileptogenic focus side by observing inhibited epileptiform discharge situation after injection.Results Bilateral synchronous epileptiform discharge of EEG in 16 patients (80%) disappeared after focus side injection,and epileptiform discharge of injection side disappeared after opposite focus side injection.Meanwhile epileptiform discharge of focus side in 4 patients (20%) still existed.Among 20 cases,the accuracy of liberalization and location in 12 cases had been proved by surgery,ECoG and DEEG.During 1～6 5 years follow-up after surgery and gamma knife treatment,clinical seizure and epileptiform discharge of EEG in 15 cases (75%) disappeared and 5 cases remitted.Conclusion Intra-carotid arterial diazepam injection was proved to has an important clinical applicable value to liberalize and Locate epileptogenic focus before surgery for patients with intractable epilepsy.