癫痫是一种常见病,我国大约有1000万癫痫患者。其中70-80%经合理药物治疗能得到控制,但仍有20-30%药物控制不良。癫痫外科主要针对的就是用药物难以控制的难治性癫痫。癫痫外科的适应症包括1)癫痫病诊断明确;2)发作频繁和程度严重影响患者的日常生活和工作;3)病程2年以上,经系统正规的药物治疗仍无明显缓解的难治性癫痫;4)患者或家属求治愿望强烈者;5)患者无严重的全身性疾病,能耐受手术者;6)有明确病因的继发性癫痫。 癫痫的外科治疗是指采用外科手术的方法去除病灶、阻断癫痫传导通路或降低皮层兴奋性,从而达到减少或消除癫痫发作的治疗方法。癫痫的手术方式有多种,其中最理想有效的方法是癫痫灶切除术,这是目前国际上推崇的方法之一,但手术前必须对癫痫灶准确定位。癫痫定位需要综合评估,术前主要检查包括磁共振、功能磁共振、脑电图(长程视频脑电检测)、脑磁图、PET等,另外,对于定位困难者,可以手术行颅内电极植入后再行视频脑电检测。癫痫手术疗效肯定。一般经过严格的术前评估和合理的手术,能使大多数所谓“难治性癫痫”达到可治、甚至治愈的目的。
【摘要】目的 探讨脑磁图癫痫定位技术对难治性癫痫致痫区定位的价值。方法 回顾性分析难治性癫痫病人58例,术前行视频头皮脑电图、磁共振、脑磁图、颅内埋藏电极皮层脑电图等检查,综合评估确定致痫灶的位置。根据综合评估致痫区制定手术方案并实施,随访并判定疗效。根据脑磁图癫痫定位和综合评估致痫区吻合度分为3组,Ⅰa组:完全吻合——两区域中心位置在1cm以内的,Ⅰb组:基本吻合——两区域中心位置在1-3cm的;Ⅱ组:不吻合——两区域中心位置在3cm以外的或其他。统计分析各组间疗效的差异。 结果 本组总有效率为77.6%(45/58),其中癫痫完全消失18例;Ⅰa、Ⅰb组手术疗效无明显差异,但Ⅰ组手术疗效明显优于Ⅱ组。结论 脑磁图癫痫定位是难治性癫痫术前评估的重要方法之一,当脑磁图癫痫定位和术前综合评估致痫区基本一致时,手术疗效相对较好。【关键词】癫痫外科;脑磁图;致痫区The value of magnetoencephalography to the localization of the epileptogenic zone in refractory epilepsy ZHANG Rui, WU Ting,LIU Hong-yi,et a1.Department of Neurosurgery,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,ChinaAbstract:Objective To evaluate the value of the magnetoencephalography to the localization of the epileptogenic zone in refractory epilepsy.Methods 58 patients with refractory epilepsy underwent video scalp EEG,MR, MEG and invasive EEG examination.The epileptogenic zones were precisely located by pre-operation evalution. The microsurgery were performed and the therapeutic effect were estimated during the follow-up. According to the relationship of the presurgical evaluated epileptogenic zones and MEG, they were divided into 3 groups,Ⅰa(3cm or others). Results Good postsurgical seizure outcome was attained in 45(77.6%) patients including 18(31.6%)who were seizure free.The therapeutic effect of group Ⅰa and Ⅰb had no significant difference (p>0.05), while groupⅠwas much better than group Ⅱ(p
癫痫病对每一个人危害极大,可是很多人对癫痫却并不是很了解,北京中日友好医院田宏博士针对患者想知道的癫痫7个经典问题,相信看后会对您有所帮助。 一、癫痫究竟是怎麽回事呢? 癫痫是神经系统常见的一种综
【摘要】目的 探讨磁源影像引导的神经导航技术在显微手术治疗顽固性癫痫的作用。方法顽固性癫痫病人14例,术前行视频脑电图、磁共振、脑磁图等检查,综合评估确定致痫灶的位置。术中运用磁源影像引导的stealstation神经导航系统及皮层脑电图,进行显微手术。结果 术中皮层脑电图与术前定位符合率100%,术后痫样放电消失9例 明显好转5例。患者神经功能保持良好。10例随访疗效满意。致痫灶的定位需要综合分析,磁源影像是一重要的定位方法,神经导航的应用有助于癫痫的微侵袭手术。【关键词】顽固性癫痫;磁源影像;神经导航 Microsurgery for refractory epilepsy with the neuronavigation under the guidance of magnetic source imaging ZHANG Rui,CHANG Yi,LIU Hong yi, et al. Department of Neurosurgery,Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029,ChinaAbstract:Objective To evaluate the value of the neuronavigation under the guidance of magnetic source imaging (MSI) in refractory epileptic microsurgery. Methods 14 patients with refractory epilepsy underwent video electroencephalgraphy, MR, and MEG examination. The epileptogenic foci were precisely located by preoperation evalution. The microsurgery were performed with the aid of the MSI guided neuronavigation and the intra operative elcetrocorticography(ECoG). Results The epileptogenic foci localization coincidence 100% between the preoperative localization and ECoG.The epileptiform discharges were disappeared in 9 patients,and significantly improved in 5 after operation. All patients have no complication.The follow up from 3 to 6 months after operation revealed a satisfactory therapeutic effect in 10 cases. Conclusions Aggregate analysis is needed to localizing the epileptogenic focus. MSI might be of important value in the localization of focus.The use of neuronavigation under the guidance of MSI is very helpful to the microinvasive surgery in the refractory epilepsy.