伴海马硬化的颞叶癫痫患者的临床特点及手术治疗

目的探讨颞叶癫痫海马硬化的临床特点及手术治疗的效果。方法伴海马硬化的颞叶癫痫患者18例,其中男10例,女8例;年龄12~37岁,病程3~10年。癫痫复杂部分性发作10例,部分性发作继发全身性发作2例,全身强直-痉挛性发作6例。结合患者的临床表现、MRI检查和视频脑电图(V-EEG)监测结果,对这18例患者行前颞叶切除术(包括大部分海马和杏仁核)。结果所有患者术中皮层和深部电极脑电图均发现颞叶皮层海马、杏仁核有异常放电,术后病理检查均证实海马硬化的诊断。术后18例患者均出现发热,但经过抗炎、腰椎穿刺及支持治疗后渐好转。术后1年以上的随访发现16例癫痫发作完全消失,2例术后较术前显著改善,仅偶有癫痫发作,但均长期服用抗癫痫药物。结论对于颞叶癫痫伴有海马硬化的患者,如果同时脑电图又发现有同侧颞叶痫样放电,则可以考虑行该侧前颞叶切除术(包括大部分海马和杏仁核),若手术切除彻底,其术后疗效也较满意。

Clinical features and surgical treatment of temporal lobe epilepsy in the patients with hippocampal sclerosis

Objective To explore the clinical features of temporal lobe epilepsy in the patients with hippocampal sclerosis and curative effects of surgery on it.Methods Of 18 patients with temporal lobe epilepsy accompanied with hippocampal sclerosis,10 were male and 8 female,and their ages ranged from 12 to 37 years.Their illness duration ranged from 3 to 10 years.The clinical manifestations included complex partial seizure in 10 cases,generalized seizure secondary to partial seizure in 2,and generalized tonoclonic seizure in 6.M RI,electroencephalogram（EEG）and video EEG（V-EEG）were performed in all the patients.All the patients underwent anteriort emporal lobectomy（including removal of the most parts of the hippocampus and amygdala）under the guidance of cortical EEG and deepE EG.Results The hippocampal sclerosis was confirmed by the postoperative pathological examination.The following-up for more than 1 year showed that the seizure disappeared in 16 cases,and was significantly alleviated in 2.Conclusions The anterior temporal lobectomy（including removal of the most parts of the hippocampus and amygdala）should be performed in the patients with temporal lobe epilepsy accompanied with hippocampal sclerosis,if the EEG shows that there are epileptic discharges in the ipsilateral temporal lobe.The curative effect of anterior temporal lobectomy（including the removal of the most parts of the hippocampus and amygdale）on the patients with temporal lobe epilepsy accompanied with hippocampal sclerosis is satisfactory.