发作期SPECT脑血流灌注显像和VEEG在癫痫灶定位诊断中的一致性

目的 探讨癫痫发作期SPECT脑血流灌注显像和视频脑电图（VEEG）在致痫灶定位中的一致性.方法 选择VEEG监测异常的癫痫患者45例,当患者出现临床发作和（或）脑电图出现典型癫痫波时30 s内注入锝-双半胱乙酯（^99Tc^m-ECD）,30 min后行脑血流灌注断层显像.比较癫痫发作期SPECT脑血流灌注显像和VEEG在癫痫定位诊断中的一致性,对部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性进行卡方检验.结果 45例癫痫患者中,发作期SPECT定位阳性率为93.3％（42/45）,均表现为高血流灌注灶,其中40例（95.2％）表现为单叶局限性高灌注,2例（4.8％）表现为多个病灶高灌注.VEEG监测结果为：31例患者VEEG表现为局灶性异常放电,明确定位达68.9％（31/45）,各导联同步对称性异常放电不能定位者占所有患者的31.1％（14/45）.比较二者定位结果发现,对于部分性发作的患者,发作期SPECT和VEEG定位的一致性为83.9％（26/31）;对于全面性-强直阵挛发作的患者,VEEG表现为各导联同步对称性异常放电,而发作期SPECT则显示为孤立高血流灌注灶,故二者定位无一致性.部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性差异有统计学意义（χ^2=24.478,P＜0.05）.结论 发作期SPECT脑血流灌注显像和VEEG在癫痫灶定位诊断中的一致性与癫痫发作类型相关.对于部分性发作的癫痫患者二者联合定位可指导手术治疗;而对于全面性-强直阵挛发作患者,发作期SPECT脑血流灌注显像和VEEG联合定位无一致性,需借助于其他检查方法方可明确定位.

The consistency of ictal SPECT and VEEG studies in localizing the epileptic focus

Objective To localize the epileptic focus by means of ictal SPECT and video-electroencephalography（VEEG） patterns to decide whether the combination of them are capable of localizing epileptic focus correctly.Methods The present study was performed in 45 epileptic patients,who showed spike waves during VEEG monitoring when deprived of sleep to provoke seizures,even oral application of clonidine was given when deprivation of sleep was failed in limited time.Technetium-99m ethyl cysteinate dimer（99Tcm-ECD）was injected within 30 s when a clinical sign and/or an typical VEEG discharge was recognized,then brain SPECT was performed after 30 min.In the end,compared the results of ictal SPECT and VEEG in localization.χ^2 test was performed by using software SPSS 19.0.Results Ictal brain SPECT localized in 93.3% （42/45）patients,of whom 95.2% （40/42）patients had single hyperperfusion,and 4.8%（2/42）had multiple hyperperfusion.VEEG showed partial seizures in 68.9% （31/45） patients,and 31.1%（14/45）patients showed generalized spike waves.The relationship of ictal SPECT and VEEG in localizing epileptic focus was turned out as following：Firstly,the consistency of ictal SPECT and VEEG is 83.9%（26/31）in partial seizure,as for generalized tonic-clonic seizure,VEEG showed generalized spike waves,and ictal brain SPECT declared single hyperperfusion,therefore,the localization of them was different.The consistency of partial seizure was significantly higher than that of generalized tonic-clonic seizure （χ^2=24.478,P〈0.05）.Conclusions The consistency of ictal SPECT and VEEG in localization has something to do with epilepsy categories.The study indicates that it is possible to obtain localization in patients with partial seizures using a combination of ictal SPECT and VEEG patterns,as for generalized tonic-clonic seizure,the combination of them is not enough and it＇ s imperative to use other techniques.