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目的评估PET与MEG定位、伽玛刀治疗顽固性癫痫临床效果和脑电图变化。方法Leksell-C型伽玛刀治疗难治性癫痫33例,30例获得随访列入研究,EEG检查26例异常。分为PET组(22例)和MEG组(8例),发作频率分别为4.8±1.9次/月和4.6±2.2次/月。根据癫痫发作特点、脑电图、PET或脑磁图、CT或MRI定位致痫灶。周边剂量为8～13Gy,中心剂量为16～45Gy,照射范围略大于PET和MEG所提示的致痫区范围。术后每3个月复查EEG,并对照术前EEG,观察癫痫发作控制情况,按国际癫痫学会分类法分为6级进行疗效判定。结果随访时间6～19个月,Ⅰ～Ⅱ级10例(33.3%),Ⅲ～Ⅳ级14例(46.7%),Ⅴ级4例(13.3%),Ⅵ级2例(6.7%)。总有效率80.0%。PET与MEG两组病例癫痫发作频次皆较术前明显减少,术后12个月分别降至2.0±1.3次/月和1.8±1.1次/月。随访EEG逐渐恢复正常12例(48.0%),好转9例(36.0%),无变化2例(8.0%),恶化2例(8.0%)。PET与MEG两组之间在治疗前后都没有差别。结论PET或MEG定位致痫灶,伽玛刀治疗顽固性癫痫疗效肯定,EEG可以在术后随访中发挥作用。
Objective To evaluate the location of PET and MEG, the clinical effect of Gamma Knife in the treatment of intractable epilepsy and the changes of EEG. Methods Thirty-three patients with refractory epilepsy were treated with Leksell-C gamma knife. Thirty patients were included in the study, and 26 patients were diagnosed by EEG. The patients were divided into PET group (n = 22) and MEG group (n = 8). The seizure frequency was 4.8 ± 1.9 times per month and 4.6 ± 2.2 times per month respectively. According to the characteristics of seizures, EEG, PET or magnetoencephalography, CT or MRI location of epileptogenic focus. Peripheral dose of 8 ~ 13Gy, the central dose of 16 ~ 45Gy, irradiation range slightly larger than PET and MEG prompted the epileptogenic zone. The EEG was reviewed every 3 months after operation and the preoperative EEG was observed. The control of epileptic seizures was observed. According to the classification of the International Epilepsy Society, the EEG was divided into 6 levels to determine the therapeutic effect. Results The follow-up time ranged from 6 months to 19 months. There were 10 cases (33.3%) of grade Ⅰ ~ Ⅱ, 14 cases of grade Ⅲ ~ Ⅳ (46.7%), 4 cases of grade V (13.3%) and 2 cases of grade Ⅵ (6.7%). The total effective rate of 80.0%. The frequency of epileptic seizures in both PET and MEG groups decreased significantly from preoperative to postoperative 12 months to 2.0 ± 1.3 times per month and 1.8 ± 1.1 times per month respectively. Follow-up EEG gradually returned to normal in 12 cases (48.0%), improvement in 9 cases (36.0%), no change in 2 cases (8.0%) and deterioration in 2 cases (8.0%). There was no difference between the two groups before and after PET and MEG treatment. Conclusions PET or MEG targeting epileptogenic lesions, gamma knife treatment of refractory epilepsy positive effect, EEG can play a role in postoperative follow-up.