摘要目的 探讨颞叶内侧癫痫的影像学、症状及电生理的多样性表现及立体定向脑电图(SEEG)的临床应用价值.方法 选取8例于清华大学玉泉医院癫痫中心行颞叶内侧切除的癫痫患者.8例患者均因不能准确定位致痫灶行立体定向颅内电极置入,并经过颅内电极证实其惯常发作起源于颞叶内侧结构,行颞叶内侧切除术后随访1年均无临床发作.结果 8例患者的症状学表现多样,头皮和颅内电极发作起始的放电形式也表现各异.颅内电极置入后显示其癫痫放电均起始于颞叶内侧结构,放电早期传导至岛叶结构者4例,传导至对侧颞叶内侧者2例,传导至压后皮质者1例,传导至顶叶者1例,传导至额叶并快速泛化者1例(1例同时传导至岛叶及对侧颞叶内侧).结论 颞叶内侧癫痫患者的临床、影像学及电生理表现存在差异,其非特异性表现可以通过颅内脑电的演变来解释,而颅内脑电可以帮助我们了解其网络传导模式.岛叶是颞叶内侧癫痫最常见的早期传导路径.在不能明确患者癫痫发作的起始部位时,立体定向脑电图可以作为一种微创、精准的术前定位手段,帮助准确定位并了解放电及传导模式.

abstractsObjective To study the diversities of imaging, symptoms, electrophysiology and clinical value of the stereoelectroencephalography(SEEG) in patients with mesial temporal lobe epilepsy.Methods Eight patients with intractable epilepsy in Epilepsy Center of Yuquan Hospital of Tsinghua University who underwent mesial temporal lobectomy were recruited in this study, and their epileptic foci could not be accurately positioned.Therefore stereotactic brain electrodes were implanted, and their usual attack originated from mesial temporal lobe structure were confirmed.There was no seizure in the one year follow-up.Results Symptoms of the eight patients behaved differently, and the onset of the seizures in scalp electroencephalograph or SEEG showed diversities.Epileptic discharges were found originated from the mesial temporal lobe after implanting electrodes: in the early stage of discharges, four cases had the conduction to insular lobe structure;two cases had the conduction to contralateral mesial temporal lobe;one case had the conduction to retrosplenial cortex;one case had the conduction to parietal lobe;one case had the conduction to frontal lobe and rapid generalization (one case had the conduction to insular lobe and contralateral mesial temporal lobe meanwhile).Conclusions There is difference in clinic, imaging and electrophysiology of the patients with mesial temporal lobe epilepsy The non-specificity can be explained by the evolution of the intracranial electroencephalography, which can help us know its network conduction pattern Insular lobe is the most common conduction approach of mesial temporal lobe epilepsy in early stage SEEG can be used as a microinvasive, accurate preoperative localization method, which can help us to locate accurately and understand the discharges and conduction mode.