检索历史 清除

目的 探讨立体定向脑电图(SEEG)引导射频热凝(RFTC)治疗难治性颞叶癫痫的临床应用价值.方法 对清华大学玉泉医院癫痫中心2016年1月至2017年11月的12例难治性颞叶癫痫患者全部行SEEG电极植入并热凝治疗.回顾性分析临床资料.结果 射频热凝后至切除术前随访(6.4±4.6)个月,切除术后随访(10.2±3.5)个月.Engel分级:Ⅰa级9例;Ⅱa,Ⅲa,Ⅳa级各1例.热凝后发作减少50％以上者9例;热凝后未行切除术2例,随访15个月无发作1例,另1例随访14个月发作减少90％以上.热凝前后发作频率差异有统计学意义(P=0.008).热凝后期行切除手术10例,术后无发作8例,其中6例热凝有效.所有患者热凝后无神经认知功能障碍,部分患者热凝后记忆商有不同程度改善.结论 虽然SEEG引导射频热凝效果不如切除术,但因其精准微创性,对于难治性颞叶癫痫患者,特别是不适合切除术者,可能会成为一种相对安全有效的治疗方法.另外,它可以有效预测切除术效果及指导手术方案.

Objective To investigate the clinical value of stereo-electroencephalography guided radiofrequency thermos-coagulation (RFTC) in drug resistant temporal epilepsy.Methods The clinical data of 12 patients with refractory temporal epilepsy who underwent implantation of SEEG electrodes and radiofrequency thermos-coagulation from July 2016 to November 2017 were analysed retrospectively.Results The mean follow-up time was 6.4 ± 4.6 months after thermos-coagulation,and 10.2 ± 3.5 months after resection.Engel Ⅰ a was observed in 9 cases,with Ⅱ a,Ⅲa and Ⅳ a 1 cases respectively.Nine patients experienced a ≥ 50％ decrease of seizure frequency after RFTC (R +,75％),of whom one had got a sustained seizure free for 15 months and the other with decrease of seizure frequency by over 90％ for 14 months.There was a statistical significance in seizure frequency between pre-and post-thermo-coagulation (P =0.008).Ten cases underwent open surgery following SEEG-guided RFTC,of them 8 cases got seizure free.RFTC was effective in 6 of 8 cases.In our group,all patients have not suffered from any neurologic and cognitive deficiency,and even several patients have some improvements on memory quotient.Conclusions Although it is less effective than resective surgery,SEEG-guided RFTC can be a relatively safe,effective treatment because of its precision and minimal invasion for patients with complex drug resistant temporal epilepsy,especially for impossible any cortical resection.In addition,its effect may be a predictor of outcome after conventional cortectomy.