摘要目的 探讨PET定位伽玛刀放射外科治疗癫痫性精神障碍(EPP)的方法及疗效.方法 45例EPP患者依据18F-2-氟-2-脱氧葡萄糖(FDG)PET显像及癫痫发作特点、脑电图、MRI等检查定位致痫灶,依据定位明确情况及患者EPP类型将病例分为2组:(1)发作性精神障碍组(PEP组),共25例,均行癫痫灶伽玛刀治疗.(2)非发作性精神障碍组(NEP),共20例,其中完成致痫灶定位的共16例(NEPc组),行癫痫灶联合胼胝体和双侧扣带回前部伽玛刀治疗；未明确定位的4例(NEPs组)仅行脑深部核团伽玛刀毁损. 结果 精神症状临床疗效总评量表(CGI)疗效指数总体良好率达到62.2％,其中PEP组和NEPs组良好率分别为72.0％和75.0％,明显高于NEPc组的43.8％.62.2％(28/45)癫痫预后达到Wieser Ⅰ～Ⅱ级,20.0％(9/45)达到Ⅲ～Ⅳ级,有效率为82.2％,其中NEPs组有效率为25.0％ (1/4),明显低于PEP和NEPc组的88.0％和87.5％. 结论 药物难治的癫痫性精神障碍患者通过伽玛刀治疗可以达到良好的效果,PEP患者可以行单纯癫痫灶伽玛射线照射,NEP患者应当联合癫痫灶伽玛射线照射及脑深部核团伽玛刀毁损的方法治疗.

abstractsObjective To study the stereotaxic Gamma knife treatment for intractable epileptic psychogney (EPP) through positron emission tomography (PET) localization and evaluate its efficacy.Methods PET examination based on 18F-Fluorodeoxyglucose (18F-FDG) was carried out on 45 patients with EPP to localize the epileptogenic foci with the help of amplitude-integrated electroencephalographic (aEEG) and MRI; the clinical characteristics,preoperative examinations and treatment effects of seizure and mental symptom of these patients were analyzed.Based on lesions and EPP types,the patients were divided into PEP group (n=25,patients with paroxysmal EPP [PEP] receiving gamma knife treatment of the epileptogenic foci) and NEP group (n=20,patients with nonprosysmal EPP [NEP]); patients in the NEP group were subdivided into NEPc group (n=16,patients with NEP receiving corpus callosotomy and frontal cingulectomy on the epileptogenic foci with gamma knife treatment) and NEPs group (n=4,patients with NEP performed stereotaxic nuclei lesion radiation by gamma knife on the deep brain only).Results Excellent rate for mental symptoms in the clinical global impression (CGI) scale reached 62.2％ in total; and that in PEP and NEPs groups was 72.0％ and 75％,respectively,which was markedly higher than that in NEPc group (43.8％).In all,62.2％ patients (28/45) reached Wieser grade Ⅰ-Ⅱ,and 20.0％ (9/45) Wieser grade Ⅲ-Ⅳ,with a total efficiency of 82.2％; and the efficiency rate in NEPs was 25％ (1/4),which was significantly lower than that in the PEP and NEPc groups (88.0％ and 87.5％,P＜0.05).Conclusion Intractable EPP could get good effect by gamma knife treatment; PEP patients can be treated by gamma knife on the epileptogenic foci and NEP patients by combined epileptogenic foci and stereotaxic nuclei lesion gamma knife radiation