128导长程视频脑电图系统在耐药性癫痫治疗中的应用

摘要

目的：观察128导长程视频脑电图系统在耐药性癫痫术前致痫灶定位、手术方式的选择及术后疗效评价中的作用。方法耐药性癫痫22例患者，采用光电128导癫痫定位系统EEG9200 K脑电图机行头皮脑电图监测，并与PET及头颅核磁检查结果进行比对。结果①9例患者头皮脑电图、头颅核磁、PET检查结果致痫灶吻合，分别进行手术治疗。术后随访3～36个月。3个月后9例患者均再次进行头皮脑电图监测，未发现癫痫发作。且随访中未见癫痫发作。②13例患者根据发作类型，经头皮脑电图、头颅核磁、PET检查后，致痫灶无法准确定位，行颅内电极及深部电极置入术，应用128导脑电图机行颅内电极脑电图长程监测，同时对功能区进行定位，选择了相应的手术方式进行治疗。术后随访3～32个月。术后3～6个月13例患者再次进行头皮脑电图监测，未见癫痫发作。11例随访中未见癫痫发作，2例术后6个月出现癫痫发作，加大抗癫痫药物剂量后未见癫痫发作。结论头皮脑电图、头颅核磁、PET检查结果致痫灶吻合可定位的应积极行手术治疗，无法定位致痫灶的患者应用128导脑电图机行颅内电极脑电图长程监测可明确致癫灶，部分可进行功能区定位，选择相应的手术方法，效果良好。颅内电极脑电图可作为致痫灶定位及手术方式选择的“金标准”。%Objective To explore the role of 128-channel long-term video electroencephalograph ( VEEG) in locating epileptogenic focus of drug-resistant epilepsy , selecting operational way and valuing efficiency of operation .Methods A total of 22 patients with drug-resistant epilepsy were analyzed with 128-channel long-term video EEG ( EEG9200K), and we compared the results with outcomes of magnetic resonance (MR) and PET.Results ①The results of scalp EEG, MR and PET fit epileptogenic foci in 9 cases well, they all underwent operation and were followed up for 3-36 months.Nine ca-ses were found that they had no seizures in three months after operation , and no seizures were found in follow-up.②Epi-leptic foci of 13 cases could not be located by scalp EEG , MR and PET, but conld be located by intracranial EEG (IEEG) with 128-channel long-term video EEG and 13 cases underwent operation .They were followed up for 3-32 months.Thirteen cases were found that they had no seizures in 3-6 months after operation .After operation for 6-36 months, 11 cases were found no seizures , and 2 cases suffered from seizures in 6 months after operation and seizure was stopped by the increased dose of AEDs .Conclusions Patients should be actively operated with fitting phase I assessment of epileptogenic foci by scalp EEG, MR and PET.Patients who couldn't be located on phase I assessment should undergo IEEG by using 128-chan-nel long-term video EEG and be operated after function orientation .IEEG can be used as gold standard for locating epilep-togenic focus and selecting the operation mode .