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目的探讨用视频脑电图和MRI诊断药物难治性癫痫的临床价值。方法收集2006年12月2010年5月间经手术和病理证实的药物难治性癫痫患者38例。其中,海马硬化25例,颞叶萎缩伴脑发育不良2例,脑灰质移位及巨脑回4例,血管畸形3例,胶质瘤2例,脑内囊肿1例,外伤性癫痫1例。用视频脑电图监测癫痫发作期及发作间期痫样放电的来源部位及脑电活动特点,用MRI扫描显示痫灶区的表现特征,并与手术、病理改变对照,进行回顾性分析。结果视频脑电图对癫痫发作期的致痫灶来源定位准确率为100%(38/38),发作间期定位准确率为53%(20/38)。MRI对发作间期的致痫灶及相关病变定位诊断准确率为89%(34/38),病变定性准确率为79%(30/38)。结论视频脑电图和MRI检查有机结合,对药物难治性癫痫,能更有效检出致痫灶的部位及性质,为药物难治性癫痫患者的手术治疗,提供重要信息。
Objective To explore the clinical value of video EEG and MRI in the diagnosis of drug refractory epilepsy. Methods Thirty-eight patients with refractory epilepsy confirmed by surgery and pathology from December 2006 to May 2010 were collected. Among them, hippocampal sclerosis in 25 cases, temporal lobe atrophy with cerebral dysplasia in 2 cases, gray matter shift and giant brain back in 4 cases, vascular malformation in 3 cases, glioma in 2 cases, 1 case of brain cysts, traumatic epilepsy in 1 case . Video EEG was used to monitor the location of the epileptiform discharges and the characteristics of electroencephalogram in the epileptic seizure and the interictal epilepsy. MRI scans were used to detect the characteristics of the epileptogenic zone, and compared with the surgical and pathological changes for retrospective analysis. Results The accuracy of location of epileptic foci by video EEG was 100% (38/38) and 53% (20/38) respectively during epileptic seizures. The diagnostic accuracy of MRI for the epileptic foci of epileptic seizures and related lesions was 89% (34/38), and the qualitative accuracy of the lesions was 79% (30/38). Conclusion The combination of video electroencephalogram (EEG) and MRI examination can detect the location and nature of the epileptogenic zone more effectively for patients with refractory epilepsy and provide important information for the surgical treatment of drug refractory epilepsy.