摘要
目的探讨颞叶癫痫颅内EEG记录与颞叶海马病变程度的关系。方法视频EEG证实为颞叶癫痫并经MRI检查的病人序贯进入本研究,采用硬膜下电极及深部电极联合纪录,确定领先发作释放(initialictaldischarge,IID)部位。37例病人中,无或轻度海马萎缩(hippocampalatrophy,HA阴性组)27例,中至中度HA(HA阳性组)者10例。海马病理变化依据MRI检查的海马容积测量及术后组织病理学的海马硬化分级。结果本组HA阴性组27例病人中,9例病人IID广泛出现在海马区、内侧旧皮层及外侧新皮层;3例在海马区及内侧古皮层;14例完全出现在海马区以外的颞叶皮层;仅1例局限于海马区。在HA阳性组中,90%的病人IID局限于海马区(P<0.05),在25例低级别海马硬化(HS)中,IID局限于海马区显著低于12例HS高级别病人(P<0.05)。结论颞叶癫痫的抽搐发作放电定位与海马的病理变化存在着密切关系,无HA和低级别HS病人的IID多出现在海马、颞叶内侧皮层、颞叶新皮层的部位,而HA明显者和高级别的HS病人出现的IID往往仅局限于海马(HF)。
Objective To determine whether the specific location of eletrographic seizure onset in the temporal lobe is related to hippocampal pathology in temporal lobe epilepsy（TLE）. Methods Conscutive presurgical patients with scalp EEG- Video evidence of TLE and no or mild hippocampal atrophy（HA） on magnetic resonance imaging（MRI） were prespectively studied by using depth and subdural strip electrode recordings to identify the site of the initial ictal discharge （IID）. Twenty - seven patients had either no or mild HA（HA- group）. Ten patients with moderate or marked HA（HA＋ group） who required depth and strip electrodes served as a comparison group. Hippocampal pathology was assessed by MRI volumetrics and histipathologic grade of sclerosis（HS）. Results Thirty-seven patients were investigated. In the HA-group, 9 patiens had lobe ictal EEG onsets in the hippocampus （HF）, medial palecortex（MPC）, and lateral neocortex（LNC） ; three cases had regional IIDs in both HF and MPC; 14patients had IIDs completely outside the HF, and only one case had an IID confined to the HF. By contrast, three（90%） of four HA ＋ cases had IIDs confined to the HF（ P 〈 0.05）. Similarly, in 25 patients with low- group often than in 12cases with high-group HS, IIDs confined to the HF area were seen significantly less often than in 12 cases with high-gradeHS（P〈 0.05）. Conclusion In this study of a large number of patiets with no to mild and a smaller group with moderate to marked HA and HS, the location of seizure onset in the temporal lobe is related to the degree of hippocampal pathology. Absence of HA and low-grade HS is each associated with IIDs in both the hippocampus and medial （with or without lateral） temporal cortex,or only the MPC or LNC. Marked HA and high-grade HS both are associated with IIDs restricted to the HF.
出处
《立体定向和功能性神经外科杂志》
2006年第1期24-27,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
颅内电极
颞叶新皮层癫痫
海马萎缩
海马硬化
Intrcranial electrodes
Neocortical temporal lobe epilepsy
Hippocampal atrophy
Hippocampal sclerosis
