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目的回顾性分析难治性癫痫手术治疗的临床资料,探讨MRI和CT阴性表现病例的致痫灶定位方法。方法经MRI和CT检查呈阴性表现的癫痫患者42例,应用发作症状评估、长程头皮和颅内电极视频脑电图(video-EEG)监测等方法综合定位致痫灶。结果 36例(85．7％)患者可以明确定位致痫灶,其中位于颞叶19例,额叶12例,额叶+颞叶3例,顶枕叶2例;多灶性起源或定位不明确者6例,2例放弃手术。40例脑致痫灶组织均有不同程度的病理改变。结论一些局灶性皮质发育不良、微发育不良等细微脑组织改变通过现有的MRI和CT影像学检查尚难以发现,而它们常常是导致癫痫发作的病理基础。综合分析患者的临床发作特点,特别是长程EEG监测资料,可为大部分的此类病例明确定位脑致痫灶。
Objective To retrospectively analyze the clinical data of surgical treatment of intractable epilepsy and explore the methods of locating the epileptic foci of MRI and CT negative cases. Methods Twenty-four patients with epilepsy were examined by MRI and CT. Epileptic foci were identified by the methods of seizure symptom assessment, long-range scalp and video-EEG monitoring of intracranial electrode. Results Twenty-six patients (85.7%) were able to locate epileptogenic foci clearly, including 19 cases of temporal lobe, 12 cases of frontal lobe, 3 cases of frontal lobe and temporal lobe and 2 cases of top occipital lobe. The multifocal origin or localization was not Clearly in 6 cases, 2 cases to give up surgery. 40 cases of epileptogenic brain tissue lesions have varying degrees of pathological changes. Conclusions Some of the subtle micro-brain tissue changes, such as focal cortical dysplasia and dysplasia, are still difficult to detect by MRI and CT imaging. However, they are often the pathological basis of seizures. A comprehensive analysis of the characteristics of the patient’s clinical attack, especially long-term EEG monitoring data, for most of these cases clear positioning of the brain-derived epileptogenic lesions.