癫痫患者致痫灶切除前后头皮脑电图的比较

目的:回顾性分析比较35例癫痫患者致痫灶切除手术前后头皮脑电图癫痫样波的变化及术后3个月头皮脑电图癫痫样渡和术后3个月内发作与否之间的关系.方法:对我院2003年35例癫痫患者致痫灶切除手术前后头皮脑电图癫痫样波的数量及术后发作情况和术后头皮脑电图癫痫样坡数量进行回顾性分析.结果:35例患者中26例术后头皮脑电图癫痫样放电较术前明显减少或消失(74.3%),9例患者术后头皮脑电图癫痫样波未见明显减少(25.7%).术后3个月内无发作30例(85.7%),其中24例(80%)术后脑电图癫痫样波明显减少或消失,6例(20%)术后头皮脑电图癫痫样渡较术前无明显变化.术后3个月内有发作5例(14.3%),其中2例(40%)术后头皮脑电图癫痫样波较术前减少,3例(60%)术后脑电图癫痫样波未见明显变化.结论:癫痫患者致痫灶切除手术可使头皮脑电图癫痫样放电明显减少,术后无发作的患者中头皮脑电图癫痫样放电减少或消失的比例高于术后有发作的患者.     

磁共振波谱分析对颞叶内侧癫痫患者脑功能定位的监测和评估作用

目的:通过对颞叶癫痫患者的磁共振波谱分析(magneticresonancespec-troscopy,MRS)结果进行分析,探讨其在诊断颞叶内侧癫痫中的作用与意义。方法:经手术治疗的颞叶癫痫患者19例,外侧型5例,内侧型14例,经术中皮质脑电图及手术后病理结果证实;手术前行脑电图、MRI及MRS检查。结果:5例颞叶外侧型癫痫患者海马区MRS检查均无异常,14例颞叶内侧型癫痫患者中6例海马区MRI显示异常,14例MRS检查均显示异常,其中1例显示双侧异常,经硬膜下埋藏电极检查左侧明显。结论:MRS可在MRI出现改变之前发现海马硬化,MRS诊断灵敏且特异性高,是颞叶内侧癫痫诊断治疗、病变功能区域监测及评估的一个可靠方法。     

磁共振影像中海马头部浅沟消失对海马区结构硬化的评估

背景MRI是目前发现检查癫痫患者海马硬化的最重要方法,主要表现为海马部位的信号异常,除此以外,MRI其他的征象对海马硬化也有提示作用.目的通过对颞叶癫痫患者的MRI信号分析,探讨海马头部浅沟消失对癫痫患者海马硬化评估的价值.设计非随机,盲法(数据收集者、结果评价者),空白对照临床实验.单位两所大学医院的放射科.对象1996-09/2002-12在上海第二医科大学附属新华医院放射科确诊为颞叶癫痫患者18例.同期选择以头痛症状来本院进行MRI检查,排除脑部存在异常的18例年龄相匹配的检查者作对照组.方法有16例癫痫患者和18例对照组MRI检查机型为GE1.5T Horizon LX全身MR机,另2例癫痫患者采用GE1.5T Signa全身MR机.由2位熟悉海马解剖,但不知具体临床和手术情况的放射科医生分析记录两组36例的72个海马头部浅沟有无消失,并将其分为3个级别消失、几乎消失和存在,同时分析记录海马有无萎缩性改变和信号异常.主要观察指标头部浅沟的显示情况,海马头部大小和信号改变情况.结果18例海马硬化患者中,16例硬化侧海马头部浅沟消失,1例硬化侧海马头部浅沟明显变浅,几乎消失,1例硬化侧海马头部浅沟存在.硬化侧海马头部均有萎缩,并在T2WI和液体衰减恢复(FLAIR)成像呈高信号.海马头部浅沟消失对海马硬化诊断的敏感性为89%(16/18),特异性为100%.结论海马头部浅沟消失是诊断海马硬化的一个可靠征象,结合患侧海马有萎缩性改变和T2加权成像信号增高,可肯定诊断海马硬化.     

难治性局灶性癫痫的多学科团队模式诊疗策略

目的:探讨难治性局灶性癫痫的多学科团队模式(multidisciplinary team, MDT)诊疗策略。方法:介绍1例药物难治性颞叶癫痫,头皮脑电图监测示患者双侧颞区不同步放电,常规磁共振序列扫描未见明显异常,初步评估为患者病灶位置和侧向性不明。进行MDT讨论和后续进一步术前评估,明确患者致痫灶和治疗方法。结果:患者为右内侧颞叶癫痫,接受右侧前颞叶+海马+杏仁核切除术,术后病理示致痫灶为节细胞胶质瘤合并局灶性皮质发育不良(局灶性皮质发育不良Ⅲb型)。术后1年余患者无癫痫发作。结论:MDT模式有助于进一步明确难治性局灶性癫痫患者的致痫灶部位,为患者的进一步手术治疗提供精准定位和手术切除范围参考,促使患者术后达到无发作状态。     

磁共振波谱分析对颞叶内侧癫痫患者脑功能定位的监测和评估作用

目的：通过对颞叶癫痫患者的磁共振波谱分析(magnetic resonance spec-troscopy，MRS)结果进行分析，探讨其在诊断颞叶内侧癫痫中的作用与意义。方法：经手术治疗的颞叶癫痫患者19例，外侧型5例，内侧型14例，经术中皮质脑电图及手术后病理结果证实；手术前行脑电图、MRI及MRS检查。结果：5例颞叶外侧型癫痫患者海马区MRS检查均无异常，14例颞叶内侧型癫痫患者中6例海马区MRI显示异常，14例MRS检查均显示异常，其中1例显示双侧异常，经硬膜下埋藏电极检查左侧明显。结论：MRS可在MRI出现改变之前发现海马硬化，MRS诊断灵敏且特异性高，是颞叶内侧癫痫诊断治疗、病变功能区域监测及评估的一个可靠方法。     

神经影像导航辅助下的颞叶前部显微切除术治疗顽固性颞叶癫痫

目的：探讨神经影像导航辅助下的颞叶前部显微切除术对顽固性颞叶癫痫的治疗效果。方法：诊断明确的顽固性颞叶癫痫病人18例，术前行脑电图、SPECT及MRI检查，明确病侧颞叶。用StealthStation神经导航系统及术中皮层脑电图，在显微镜下行颞叶前部及海马全切除术。结果：14例术后无发作，脑电图检查未见痫样放电；4例发作次数减少，其中2例脑电图见对侧颞叶痫样放电。术后患者神经功能保持良好，未出现明显后遗症。结论：神经影像导航辅助下的颞叶前部及海马显微切除术是治疗顽固性颞叶癫痫的有效方法；对于诊断明确的颞叶癫痫应尽早手术，以免癫痫频繁发作造成对侧的继发性损伤。     

40例颞叶癫痫与海马硬化的MRI研究

目的探讨原发性颞叶癫痫与海马硬化-MRI之间的关系。方法40例颞叶癫痫患者的海马面积计算采用电子计算机,用BIOCOM2000软件分析MRI图像,并计算出海马体积,用AI(不对称指数)表示海马萎缩程度。结果有海马萎缩者占70%,无海马萎缩者占30%,与脑电图检查非常符合,其敏感性达93%,特异性为86%。结论原发性颞叶癫痫与海马硬化有关。MRI是检测海马硬化的首选方法。     

癫痫患者的临床观察及护理

现将我院近年应用抗癫痫药物治疗 2 6 8例癫痫患者的护理体会报道如下。1　资料与方法1 1　临床资料　 2 6 8例患者中男 139例 ,女 12 9例 ,1～ 6 5岁 ,病程≥ 1年 6 8例 ,1～ 10年 16 6例 ,>10年 34例 ,治疗前血常规、肝功能检查均正常 ;脑电图检查示正常 6 3例 ,中、重度异常 10 1例 ,癫痫样放电 47例 ,局限性异常 2 5例 ,儿童异常脑电图 32例。1 2　分组　按照癫痫发作频率及类型分为 3组 ,癫痫发作频率每年 <10次为低频组 ,每月或每周发作 1次为高频组 ,小发作为高频小发作组。按照癫痫发作类型分为全身性、局限性和混合性发作。1 3　方…     

颞叶癫痫患者的睡眠结构研究

目的:探讨颞叶癫痫(TLE)患者发作间期睡眠结构的特点及发作间期痫样放电(IEDs)对睡眠结构的影响.方法:TIE组26例,正常对照组20例;对两组分别进行Epworth思睡量表(ESS)、Zung氏抑郁自评量表(SDS)、Zung氏焦虑自评量表(SAS)评分,并进行全夜视频多导睡眠仪监测,并根据睡眠过程中是否记录到发作间期痫样放电将TLE患者再分为有IEDs组与无IEDs组分别进行统计,评价TLE组与正常对照组之间、发作间期痫样放电组与发作间期无痈样放电组之间的睡眠结构参数及ESS、SAS、SDS等各项评分的差异.结果:(1)TLE组与正常对照组相比NREM1期比例增加(P<0.05)、觉醒期比例增加(P<0.05)、REM潜伏期延长(P<0.05)、总睡眠时间减少(P<0.05)、睡眠效率下降(P<0.05)、觉醒次数增加(P<0.01)、入睡后觉醒时间增加(P<0.05);(2)在多导睡眠监测中有16例(61.5%)记录到了发作间期痫样放电、10例(38.5%)未记录到IEDs,有IEDs组与无IEDs组比较REM潜伏期延长(P<0.05)、睡眠效率下降(P<0.05);(3)TLE组的Epworth评分明显高于对照组(P<0.05),有IEDs组与无IEDs组Epworth评分无明显差异(P>0.05).结论:TLE患者睡眠结构紊乱,睡眠进程受影响;IEDs可在TLE患者睡眠中出现,IEDs与睡眠有着密切的关系.     

颞叶癫痫内侧颞叶结构体积变化及与临床因素相关性研究

目的：探讨颞叶癫痫（TLE）海马、杏仁核及内嗅皮层体积变化及与临床的相关性。方法：采用MRI对117例TLE患者的海马、杏仁核及内嗅皮层体积进行测量并进行临床相关性研究。结果：有侧别优势的TLE患侧海马体积较对侧小，其中海马硬化组患侧和对侧内嗅皮层体积也存在差异，而杏仁核体积均未见明显差异；海马及杏仁核体积变化与发作频率、起病年龄的早晚、病程长短、高热惊厥之间未见明显相关性，海马硬化组内嗅皮层体积减少程度与复杂部分性发作频率存在相关性。结论：内侧颞叶结构对颞叶癫痫相关的损伤敏感性存在差别。     

Safety and seizure control in patients with mesial temporal lobe epilepsy treated with regional superselective intra‐arterial injection of autologous bone marrow mononuclear cells

Temporal lobe epilepsy (TLE) is a highly prevalent syndrome among people with epilepsy, and is usually refractory to drug treatment. Structural and physiological changes, such as hippocampal sclerosis, are often present in TLE patients. The objective of this study is to evaluate the feasibility and safety of intra‐arterial infusion of autologous bone marrow mononuclear cells (BMMC) in adults with medically refractory mesial TLE (MTLE) and unilateral hippocampal sclerosis (HS). We enrolled 20 patients who had been diagnosed with MTLE‐HS and were refractory to medical treatment. All patients underwent a neurological evaluation, magnetic resonance imaging with hippocampal volumetry, video‐electroencephalography (EEG) with ictal recording, and a neuropsychological test battery focusing on verbal and nonverbal memory domains. After bone marrow aspiration and subsequent cell preparation, the BMMC were infused by selective posterior cerebral artery catheterization. Patients were followed for 6 months. Safety of the procedure, seizure frequency, neuropsychological evaluation, EEG variables, routine brain magnetic resonance imaging and hippocampal volumetry were considered measurements of outcome. Any serious intercurrent clinical event or adverse effects related to the procedure were reported. No additional lesions and no significant hippocampal volumetric changes were observed. EEG recordings showed a decrease in theta activity and spike density. At 6 months, eight patients (40%) were seizure free. A significant increase in the memory scores over time was observed. The BMMC autologous transplant for the treatment of temporal lobe epilepsy is feasible and safe. The seizure control achieved in this novel study supports the therapeutic potential of stem cell transplants in MTLE‐HS patients. Copyright © 2016 John Wiley & Sons, Ltd.     

联合磁源性影像和磁共振波谱技术评估颞叶癫痫的价值

目的：探讨磁源性成像（MSI）和磁共振波谱（^1H—MRS）技术结合在颞叶癫痫诊断定位中的价值。方法：设健康对照者10例，特发颞叶癫痫患者8例，应用MEG定位痫性病灶，选取MEG异常区域、对侧相应区域和双颞叶内侧区域测量NAA／Cho值，并观察是否存在海马硬化。结果：8例患者MEG检查结果均异常，6例MEG异常相应区域MRS检查NAA／Cho值减少，符合率为62．5％；MRI显示海马硬化2例，MRI正常6例，颞叶内侧MRS扫描未见明显改变。结论：联合MSI和MRS技术可进一步提高颞叶癫痫致痫灶的定位准确性。     

Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings

To compare magnetoencephalography (MEG) with scalp electroencephalography (EEG) in the detection of interictal spikes in temporal lobe epilepsy (TLE), we simultaneously recorded MEG and scalp EEG with a whole-scalp neuromagnetometer in 46 TLE patients. We visually searched interictal spikes on MEG and EEG channels and classified them into three types according to their presentation on MEG alone (M-spikes), EEG alone (E-spikes), or concomitantly on both modalities (M/E-spikes). The M-spikes and M/E-spikes were localized with MEG equivalent current dipole modeling. We analyzed the relative contribution of MEG and EEG in the overall yield of spike detection and also compared M-spikes with M/E-spikes in terms of dipole locations and strengths. During the 30- to 40-min MEG recordings, interictal spikes were obtained in 36 (78.3%) of the 46 patients. Among the 36 patients, most spikes were M/E-spikes (68.3%), some were M-spikes (22.1%), and some were E-spikes (9.7%). In comparison with EEG, MEG gave better spike yield in patients with lateral TLE. Sources of M/E- and M-spikes were situated in the same anatomical regions, whereas the average dipole strength was larger for M/E- than M-spikes. In conclusion, some interictal spikes appeared selectively on either MEG or EEG channels in TLE patients although more spikes were simultaneously identified on both modalities. Thus, simultaneous MEG and EEG recordings help to enhance spike detection. Identification of M-spikes would offer important localization of irritative foci, especially in patients with lateral TLE.     

Characteristics of postictal headache in patients with partial epilepsy

Migraine-like features sometimes characterize the headache that follows epileptic seizure (postictal headache, PIH). We compared patients with different types of epilepsy to investigate the association between migraine-like PIH and seizure type. Subjects comprised 364 patients with partial epilepsy. Epilepsy types were temporal lobe epilepsy (TLE, n = 177), frontal lobe epilepsy (FLE, n = 116), and occipital lobe epilepsy (OLE, n = 71). Patients participated in a structured interview pertaining to PIH as well as interictal headache and family history of migraine. Headaches were classified according to the International Headache Society criteria, which was modified for this study. Forty percent had PIH and 26% of these patients had migraine-like PIH. Migraine-like PIH occurred significantly more often in cases of TLE and OLE than in cases of FLE. In addition, the incidence of interictal migraine headache was significantly higher in patients with migraine-like PIH. These results suggest that migraine-like PIH is related to particular regions of epileptogenic focus and that susceptibility to migraine headache predisposes to migraine-like PIH.     

Correlations of interictal FDG-PET metabolism and ictal SPECT perfusion changes in human temporal lobe epilepsy with hippocampal sclerosis

BACKGROUND: The pathophysiological role of the extensive interictal cerebral hypometabolism in complex partial seizures (CPS) in refractory mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) is poorly understood. Our aim was to study ictal-interictal SPECT perfusion versus interictal fluorodeoxyglucose (FDG)-PET metabolic patterns. METHODS: Eleven adults with refractory unilateral mTLE-HS, who were rendered seizure free after epilepsy surgery, were included. All had an interictal FDG-PET and an interictal and ictal perfusion SPECT scan. FDG-PET data were reconstructed using an anatomy-based reconstruction algorithm, which corrected for partial volume effects, and analyzed semi-quantitatively after normalization to white matter activity. Using Statistical Parametric Mapping (SPM), we compared interictal metabolism of the patient group with a control group. We correlated metabolic with ictal perfusion changes in the patient group. RESULTS: Global cerebral grey matter glucose metabolism in patients was decreased 10-25% compared with control subjects. Interictal PET hypometabolism and ictal SPECT hypoperfusion were maximal in the ipsilateral frontal lobe. Ictal frontal lobe hypoperfusion was associated with crossed cerebellar diaschisis. The ipsilateral temporal lobe showed maximal ictal hyperperfusion and interictal hypometabolism, which was relatively mild compared with the degree of hypometabolism affecting the frontal lobes. CONCLUSION: Interictal hypometabolism in mTLE-HS was greatest in the ipsilateral frontal lobe and represented a seizure-related dynamic process in view of further ictal decreases. Crossed cerebellar diaschisis suggested that there is a strong ipsilateral frontal lobe inhibition during CPS. We speculate that surround inhibition in the frontal lobe is a dynamic defense mechanism against seizure propagation, and may be responsible for functional deficits observed in mTLE.     

Quantitative analysis of temporal lobe white matter T2 relaxation time in temporal lobe epilepsy

The objective of this study was to assess temporal lobe white matter (WM) quantitatively using T2 relaxometry in patients with pharmacologically intractable temporal lobe epilepsy (TLE). T2 relaxometry was performed using a dual-echo sequence with 23 contiguous oblique coronal slices in 56 consecutive TLE patients and in 30 healthy subjects. Averages of six slices were chosen to calculate T2 relaxation time in the temporal lobe WM (WM-T2) and the hippocampus (Hippo-T2). Twenty-seven patients had unilateral hippocampal atrophy (HA), and twenty-nine patients had normal hippocampal volumes (NV) on volumetric MRI. Mean WM-T2 was increased ipsilateral to the seizure focus in TLE patients with HA and those with NV (P < 0.001). Contralateral mean WM-T2 was increased in left and right TLE with HA (P < 0.001) and in right TLE with NV (P = 0.001). There was a positive correlation between WM-T2 and Hippo-T2. Individual analysis showed a prolongation of WM-T2 in about 70% of TLE patients with HA and NV. In half of the patients, WM-T2 increase was bilateral and symmetric. However, in 33% of patients with NV and bilateral symmetric increase in Hippo-T2, WM-T2 provided a correct lateralization of the seizure focus. Regardless of the pattern of T2 abnormalities, that is, bilateral symmetric or ipsilateral, the majority of patients with HA became seizure-free after surgery, while those with NV did not have a favorable outcome. In patients with NV, WM-T2 measurement may provide additional lateralizing information compared to Hippo-T2.     

Resting functional MRI with temporal clustering analysis for localization of epileptic activity without EEG

We report on the methods and initial findings of a novel noninvasive technique, resting functional magnetic resonance imaging (fMRI) with temporal clustering analysis (TCA), for localizing interictal epileptic activity. Nine subjects were studied including six temporal lobe epilepsy (TLE) patients with confirmed localization indicated by successful seizure control after resection. The remaining three subjects had standard presurgical evaluations with inconsistent results or suspected extratemporal lobe foci. Peaks of activity, presumably epileptic, were detected in all nine subjects, using the resting functional MRI with temporal clustering analysis. In all six patients who underwent resective surgery, the fMRI with temporal clustering analysis accurately determined the epileptogenic hippocampal hemisphere (P = 0.005). In the three subjects without confirmed localization, the technique determined regions of activity consistent with those determined by the presurgical assessments. Though more studies are required to validate this technique, the results demonstrate the potential of the resting fMRI with temporal clustering technique to detect and localize epileptic activity without the need for simultaneous electroencephalography (EEG). The greatest potential benefit of this technique will be in the evaluation of patients with suspected extratemporal lobe epilepsy and patients whose standard assessments are discordant.     

儿童颞叶中内侧硬化所致颞叶癫痫的MRI研究

目的 对儿童颢叶癫痫进行前瞻性MRI研究分析。探讨儿童颢叶癫痫的MRI表现特征。方法 对127例临床和脑电图检查诊断为颢叶癫痫的儿童进行MRI多序列成像．分析研究颞叶的形态结构、信号并判断海马有无萎缩性改变。结果 127例颢叶癫痫患儿中，9例(7．1％)海马有萎缩性改变，且在T2加权成像和液体率减恢复(F1AIR)成像上呈高信号。9例中，6例伴有海马受累同侧颞叶信号异常；3例伴有同侧颞叶皮层结构不良；1例伴有同侧颞叶萎缩。结论 颞叶中内侧硬化是儿童颢叶癫痫的一个相对少见原因，受累侧海马MRI表现为萎缩和信号异常，同时常伴海马外颞叶结构受累。     

Neural correlates of working memory in Temporal Lobe Epilepsy--an fMRI study

It has traditionally been held that the hippocampus is not part of the neural substrate of working memory (WM), and that WM is preserved in Temporal Lobe Epilepsy (TLE). Recent imaging and neuropsychological data suggest this view may need revision. The aim of this study was to investigate the neural correlates of WM in TLE using functional MRI (fMRI). We used a visuo-spatial 'n-back' paradigm to compare WM network activity in 38 unilateral hippocampal sclerosis (HS) patients (19 left) and 15 healthy controls. WM performance was impaired in both left and right HS groups compared to controls. The TLE groups showed reduced right superior parietal lobe activity during single- and multiple-item WM. No significant hippocampal activation was found during the active task in any group, but the hippocampi progressively deactivated as the task demand increased. This effect was bilateral for controls, whereas the TLE patients showed progressive unilateral deactivation only contralateral to the side of the hippocampal sclerosis and seizure focus. Progressive deactivation of the posterior medial temporal lobe was associated with better performance in all groups. Our results suggest that WM is impaired in unilateral HS and the underlying neural correlates of WM are disrupted. Our findings suggest that hippocampal activity is progressively suppressed as the WM load increases, with maintenance of good performance. Implications for understanding the role of the hippocampus in WM are discussed.     

Voxel-by-voxel comparison of automatically segmented cerebral gray matter--A rater-independent comparison of structural MRI in patients with epilepsy.

Quantitative evaluation of MRI in patients with epilepsy can give more information than qualitative assessment. Previously developed volume-of-interest-based methods identified subtle widespread structural changes in the neocortex beyond the visualized lesions in patients with malformations of cortical development (MCD) and hippocampal sclerosis (HS) and also in MRI-negative patients with juvenile myoclonic epilepsy (JME). This study evaluates a voxel-based automated analysis of structural MRI in epilepsy. After fully automated segmentation of cerebral gray matter from structural T1-weighted, high-resolution MRI scans, we applied the automated and objective technique of statistical parametric mapping (SPM) to the analysis of gray matter of 35 control subjects, 10 patients with partial seizures and MCD, 10 patients with left temporal lobe epilepsy (TLE) and HS, 10 patients with left TLE and normal MR quantitation of the hippocampus, and 20 patients with JME. At a corrected threshold of P < 0.05, significant abnormalities were found in 3/35 controls; in all 10 patients with MCD, 6 of whom had additional lesions beyond the margins of the visualized abnormalities; in 2/10 TLE patients with HS; in 2/10 MRI-negative TLE; and in 4/20 JME patients. Group comparisons between control subjects and HS patients identified the affected left temporal lobe with an increase in gray matter in the posterior temporal lobe, but did not identify hippocampal atrophy. The group of MRI-negative TLE patients showed no abnormalities compared with control subjects. Group comparison between control subjects and JME patients identified a mesial frontal increase in gray matter. The SPM-based voxel-by-voxel comparison of gray matter distribution identified MCD and abnormalities beyond the visualized lesion in individual MCD patients. The method did not reliably identify HS in individual patients or identify abnormalities in individual MRI-negative patients with TLE or JME in a proportion larger than the chance findings in the control group. Using group comparisons, structural abnormalities in the neocortical gray matter of patients with TLE and HS were lateralized to the affected temporal lobe. In patients with JME as a group, an increase in gray matter was localized to the mesial frontal area, corroborating earlier quantitative MRI findings.