摘要目的 通过立体脑电图电极皮质电刺激的方法探讨岛叶或岛叶相关药物难治性癫痫患者双侧岛叶之间的功能连接情况.方法 回顾性分析2014年1月至2016年8月清华大学玉泉医院癫痫中心收治的4例岛叶或岛叶相关药物难治性癫痫患者的临床资料.4例患者均于双侧岛叶植入立体脑电图电极进行皮质电刺激,通过视觉分析和非参数检验确定每个触点有无诱发电位响应.采用刺激一侧的对侧岛叶的电极记录诱发电位响应,明确刺激响应率及解剖分布情况.结果 4例患者共植入28根SEEG电极(98个触点),其中植入左侧岛叶12根电极(47个触点).4例患者的双侧岛叶之间有皮质-皮质诱发电位(CCEP)响应.刺激一侧岛叶时,对侧岛叶CCEP的响应率为39.8％,峰潜伏期为15.5 ～ 196.0 ms.此外,在双侧岛叶等位脑回间存在双向CCEP联系.结论 岛叶或岛叶相关的难治性癫痫患者的双侧岛叶之间存在双向功能连接,特别是病毒性脑炎后癫痫患者,其双侧岛叶之间的连接更为广泛.但这一结果尚需更多病例来进一步证实.

abstractsObjective To explore bilateral insular functional connectivity in refractory epilepsy patients using electrical cortical stimulation by stereoelectroencephalography (SEEG) electrodes.Methods We retrospectively analyzed the clinical data of 4 patients with insular or insular-related drug resistant epilepsy at Epilepsy Center of Yuquan Hospital of Tsinghua University from January 2014 to August 2016.Four patients were implanted with SEEG electrodes in bilateral insular lobes for cortical electrical stimulation.The evoked potential response of each contact was determined by visual analysis and nonparametric test.The evoked potential response was recorded at the contralateral insular lobe electrode on the stimulating side,and the response rate and anatomical distribution were determined.Results A total of 28 SEEG electrodes (98 contacts) were implanted into the insular lobe in 4 patients,of which 12 electrodes (47 contacts) were implanted into the left insular lobe.Cortical-cortical evoked potential (CCEP) responses were found between bilateral insular lobes in 4 patients,and homotopic bidirectional CCEP connections were found between bilateral insular lobes.The response rate of contralateral insular CCEP was 39.8％,and the peak latency was 15.5-196.0 ms.There were bi-directional CCEP connections between corresponding bilateral insular gyri.Conclusions There are bi-directional functional connections between bilateral insular lobes in patients with insular or insular-related epilepsy,particularly in patients with post-viral encephalitis epilepsy.However,more studies are needed to confirm this result.