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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:

期数:

2015年03期

页码:

176-180

栏目:

癫痫专题 论著

出版日期:

2015-06-15

文章信息/Info

Title:

Electro-Clinical Characteristics of Temporo-Occipital Conjunction Epilepsy

作者:

张冰清;  周文静;  王海洋

清华大学玉泉医院

关键词:

癫痫; 颞后-枕皮层; 后头部癫痫; 致痫区

Keywords:

Epilepsy;  Temporo-occipital cortex;  Posterior cortex epilepsy;  Epileptogenic zone

分类号:

R742.1

文献标志码:

A

摘要:

目的：探讨神经影像学、电生理及症状学在起源于颞后-枕交界区癫痫患者术前评估中的价值。方法学：回顾性分析2010年1月至2012年12月清华大学玉泉医院神经外科五病区经颅内电极证实发作起源于颞后-枕交界区的7癫痫患者，术后随访1年以上无发作，分析其头颅MRI、电生理及发作症状学特点及定侧、定位信息。结果：⑴头颅MRI：3例患者致痫区同侧颞枕交界区、枕叶或颞顶枕交界区病灶，2例患者致痫区同侧海马硬化，2例阴性。⑵间歇期放电脑区：2例为致痫区同侧后头部，3例为累及额、颞及后头部等多脑区，其中致痫区同侧颞区著1例，致痫区同侧后头部著2例；2例为致痫区同侧半球弥漫性，颞区著1例，后头部著1例。⑶发作期脑电图：3例为致痫区同侧后头部起始；4例为弥漫性起始，致痫区同侧后头部著2例，致痫区同侧颞区著1例，同侧半球著1例。⑷发作症状学：6例患者视觉先兆，1例患者有头部先兆；5例患者有自动症发作，6例患者对侧肢体强直/强直-阵挛，其中4例患者既有自动症发作又有强直发作。结论：与头颅MRI相比，间歇期VEEG、发作期VEEG及症状学提供了更多的定侧、定位信息，特别是症状学先兆及体征的定侧及定位信息更大。而头颅MRI在一定程度上可以造成误导，往往出现致痫灶同侧颞叶内侧结构的信号异常。

Abstract:

Objectiv: To study the lateralized and localized values of neuroimaging,electrophysiology and clinical symptomatology on the temporo-occipital conjunction epilepsy. Method: Retrospective analysed the MRI, electrophysiological and seizure semiology of 7 temporo-occipital conjunction epilepsy patients after intracranial electrode confirmed during January 2010 to December 2012 in Department five of Neurosurgery of Yuquan Hospital of Tsinghua University. Patients were without seizures postoperation for at least 1 year. Result: ⑴Three patients’MRI showed lesion on ipsilateral temporo-occtipital conjunction, temporal lobe or temporo-parieto-occipital lobe. Two patients’MRI showed ipsilateral hippocampus sclerosis. Two patients’MRI were normal.⑵ Iterictal EEG: 2 patients had ipsilateral posterior head discharges,3 patients had multiple brain regions discharges including frontal, temporal and posterior cortex. 2 patients had diffused discharges, one patient temporal dorminant, one patient posterior region dorminant.⑶Ictal EEG showed ipsilateral posterior cortex onset in 3 patients and diffused onset in 4 patient, which posterior cortex dorminant in 2 patients, temporal region dorminant in 1patient and ipsilateral hemisphere dorminant in 1patient.⑷Semiology：6patients had visual aruas, 1 patient had cephalic arua, 5 patients had aurtomatis sezure. 6 patients had contralateral limbs tonic or tonic-clonic sezuire. And 4 patients had automatism seizure and tonic seizure。Conclusion: Compared with the head MRI, interictal VEEG, ictal VEEG and symptomatology provides more information for location epileptogenic zone, especially the aura seizure and signs. And head MRI were misleading to some extent, often showed ipsilateral medial temporal lobe structure signal abnormalities.

备注/Memo

备注/Memo:

［收稿日期］ 2014-11-13 [基金项目]国家重点基础研究发展计划（973计划）

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更新日期/Last Update: 2015-06-15