颞叶附加癫痫

Temporalplusepilepsy(TPE)周健神经外科首都医科大学三博脑科医院中国.北京2023.5颞叶癫痫旳手术疗效Of168patientsincluded,108(63.7%)underwentstereoelectroencephalography,131(78%)hadhippocampalsclerosis,149sufferedfromunilateraltemporallobeepilepsy(88.7%),onefrombitemporalepilepsy(0.6%)and18(10.7%)fromtemporalplusepilepsy.TheprobabilityofEngelclassIoutcomeat10yearsoffollow-upwas67.3%(95%CI:63.4–71.2)fortheentirecohort,74.5%(95%CI:70.6–78.4)forunilateraltemporallobeepilepsy,and14.8%(95%CI:5.9–23.7)fortemporalplusepilepsy.Multivariateanalysesdemonstratedfourpredictorsofseizurerelapse:

※temporalplusepilepsy(P<0.001),※postoperativehippocampalremnant(P=0.001),※pasthistoryoftraumaticorinfectiousbraininsult(P=0.022),※secondarygeneralizedtonic-clonicseizures(P=0.023).颞叶附加癫痫旳简介Thetermoftemporal‘plus’(Tt)epilepsieshasrecentlybeensuggested(RyvlinandKahane,2023)todescribespecificformsofseizuresofmultilobaroriginwhicharecharacterizedbytheinvolvementofacomplexepileptogenicnetworkincludingthetemporallobeandtheclosedneighbouredstructures,suchastheorbito-frontalcortex,theinsula,thefrontalandparietaloperculumandthetemporo–parieto–occipitaljunction.InadepthEEGstudyaimingatverifyingtheroleoftheperisylviancortexinseizuresinvolvingthetemporallobe,Kahaneetal.(2023)showedthatsixofthesevenpatientsinwhomseizuresarosefromtemporalandsuprasylvianopercularcortices,andinwhomanadequatetemporo-perisylvianresectioncouldbeachieved,weretotallyseizure-freeaftersurgery.Temporallobesurgeryalonewasunsuccessfulinthetwotemporo-insularcasesofIsnardetal.(2023),sinceitallowedthemtosuppresstheseizuresoftemporallobeorigin,butnotthosewhicharosefromtheinsula.Moreover,anteriortemporalresectiondidnotbenefitthepatientswithictaltemporo-parietalsymptoms(reportedbyAghakhanietal.,2023)Temporallobectomyfailedtocontrolseizuresinfourofthesixpatientswithposteriorbasaltemporalictalonset,reportedbyPrasadetal.(2023)癫痫外科旳术前评估PhaseI—History,Physical,VEEGMonitoringNeuropsychologytesting,Imaging(CT,MRI,PET,SPECT,MRS,fMR)PhaseII—IntracarotidAmytalTest(WADA)PhaseIII—IntracranialMonitoringwithacombinationofdepth,Strip,andGridElectrodes癫痫外科旳术前评估CasediscussionYuanMFemale,26yrsR-handed病例特点

辅助检验

头皮脑电图

头颅MRI

头PET

神经心理评估

颅内电极置入病例特点女性，26岁，右利手，病史23年现病史：12岁首次发作，主要体现为：GTCS，连续约1-2min缓解，今后一周内出现2次类似症状，服用丙戊酸钠后2年无发作；目前发作类型：精神先兆（似曾相识感）→言语自动→自动运动（吞咽、双手探索）→GTCS，发作后不能回忆发作过程治疗：丙戊酸钠、拉莫三嗪个人史：母孕期正常，足月顺产，无生后缺氧窒息史；生长发育正常家族史：否定类似家族史ScalpEEGBGa-YuanMScalpEEGSZ-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanM

头皮脑电图间歇期：未见经典癫痫样放电发作期：1.临床：全身动作降低→自动运动→

植物神经症状→复杂运动

2.EEG：发作型，弥漫性，左侧前头部辅助检验

头皮脑电图

头颅MRI

头PET

神经心理评估

辅助检验

头皮脑电图

头颅MRI

头PET

神经心理评估

AFBJCDELM左侧半球左侧半球：A颞中回-杏仁核（16）B颞中回-海马头（16）C颞中回中部-海马旁回（16）D颞中回后部-海马后部（16）E颞上回-第2岛长回（12）F颞极（12）J额中回-第2-3岛短回、第1岛长回（斜视16）L角回-扣带回（16）M颞中回后部颞枕交界-颞底-海马头下方（斜插16）N额上回-扣带回-额底内侧面（斜插16）右侧半球B’颞中回-海马头（16）LN左侧半球左侧半球：A颞中回-杏仁核（16）B颞中回-海马头（16）C颞中回中部-海马旁回（16）D颞中回后部-海马后部（16）E颞上回-第2岛长回（12）F颞极（12）J额中回-第2-3岛短回、第1岛长回（斜视16）L角回-扣带回（16）M颞中回后部颞枕交界-颞底-海马头下方（斜插16）N额上回-扣带回-额底内侧面（斜插16）右侧半球B’颞中回-海马头（16）SEEGSZonset-YuanM临床：精神先兆（1/5）→自动运动→植物神经症状→复杂运动（1/5）LOCEEG：N1-2电极接触点低波幅快活动→低