局灶性皮质发育不良癫痫患者发作间期皮质脑电图特点及其病理学改变

目的 通过分析局灶性皮质发育不良(FCD)癫痫皮质脑电图发作间期异常放电(IED)的表现特点与其病理学改变之间的相互关系,探讨应用IED判断致痫灶的可能性.方法 以22例术前采用长程颅内电极埋置,术后病理学证实为FCD的患者为研究对象,根据长程颅内皮质脑电图监测结果,将患者的皮质IED分为4类:棘波、重复性棘慢波、多棘波以及低波幅快节律.手术中将IED集中且可能为致痫灶的皮质部位切除后,除常规病理学分析外,根据微小清蛋白(PV)免疫组化染色评价标准进行半定量分析对比.结果 共收集到完整的病理标本20例.经统计各IED分型之间组织标本的PV评分差异无统计学意义(F=1.198,P>0.05),但在数值上,棘波的PV平均分数最高,为8.00;多棘波的最低,为5.60.FCDI型中,棘波占58%,明显多于其他3类IED,而3例FCD Ⅱ B患者的IED皆为低波幅快节律.结论 虽然应用PV半定量评分标准分析各种IED类型问的致痫性差异不大,但棘波的PV值最高,而且重复性棘慢波、多棘慢波与低波幅快节律在FCD病理严重程度级别高的患者中更易出现,提示它们的致痫性有高于棘波的趋势.

Correlation between characteristics of interictal epilepiform discharge and histopathological change in epilepsy patients with focal cortical dysplasia

Objective To discuss the correlation between characteristics of interictal epilepiform discharge(IED) and histopathological changes in epilepsy patients with focal cortical dysplasia(FCD) in order to explore the epileptogenicity of various IED. Methods Twenty-two consecutive patients suspected as with FCD who were to undergo epilepsy surgery received intracranial electrode implantation and long-term video-EEG monitoring before the resective surgery and the postoperative pathology proved the diagnosis of FCD. According the long-term EEG monitoring results, the IEDs were divided into four catalogs: isolated spike, slow repetitive spike, repetitive spike, and paroxysmal fast. The possible epileptogenic cortex with intense lED was reseeted in the operation to undergo histopathologic study and hemi-quantificational scoring of parvalbumin (PV) by immunocytochemistry. Results The reseeted specimens of 20 cases were studied.There were not significant differences in the PV quantificational score between any 2 IED subtypes (F=1.198, P =0.342). However, the spike type had the highest PV score: 8.00, while the repetitive spike type had the lowest PV score:5.60. On the other hand, FCD of different severity in terms of pathological changes tended to have different kind of IED. Conclusion Despite the insignificant differences between various kinds of IED, isolated spike has the highest PV scores meaning lower epileptogenicity. Slow repetitive spike, repetitive spike, and paroxysmal fast tend to occur in more severe FCD patients which mean a great possibility of epileptogenicity.