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  • 吴海洋,史哲,沈云娟,史雪峰,兰正波,韩彦明,张新定*.多模态癫癎评估体系在局灶性脑发育不良相关癫中的应用[J].第二军医大学学报,2019,40(12):1378-1383    [点击复制]
  • WU Hai-yang,SHI Zhe,SHEN Yun-juan,SHI Xue-feng,LAN Zheng-bo,HAN Yan-ming,ZHANG Xin-ding*.Application of multimodal epilepsy assessment system in focal cortical dysplasia-related epilepsy[J].Acad J Sec Mil Med Univ,2019,40(12):1378-1383   [点击复制]
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多模态癫癎评估体系在局灶性脑发育不良相关癫中的应用
吴海洋,史哲,沈云娟,史雪峰,兰正波,韩彦明,张新定*
0
(兰州大学第二医院神经外科, 神经外科实验室, 兰州大学神经病学研究所, 兰州 730000
*通信作者)
摘要:
目的 提出多模态癫癎评估体系,并应用此体系指导局灶性脑发育不良(FCD)癫癎发作患者的手术治疗,探讨其对改善FCD癫癎发作患者手术预后的价值。方法 选择2016年10月至2018年11月在兰州大学第二医院行手术治疗、术后病理证实为FCD的癫癎发作患者22例,所有患者在围手术期均采用多模态癫癎评估体系进行评估,评估手段包括发作症状学评估、结构影像学检查、长程头皮视频脑电图监测、正电子发射计算机断层显像、影像融合分析、磁共振成像(MRI)。采用Engel疗效分级系统判断预后,EngelⅠ级为癫癎控制效果良好,EngelⅡ~Ⅳ级为控制不佳。用Fisher确切概率法分析性别、年龄、病理分型、MRI检查、病灶位置、病程和脑电图-症状-解剖学定位一致性等对患者预后的影响。结果 22例患者(男13例,女9例)均行手术切除病灶,随访4~28个月,EngelⅠ级18例、Ⅱ级2例、Ⅲ级1例、Ⅳ级1例,控制良好率为81.8%(18/22)。Fisher确切概率法统计分析显示,病程、脑电图-症状-解剖学定位一致性是FCD癫癎发作患者手术疗效的影响因素(P=0.045、0.005),而年龄、病灶位置、性别、病理分型、MRI检查结果对预后无明显影响(P均>0.05)。结论 多模态癫癎评估体系可以更准确地定位FCD癫癎发作患者的致灶,为癫癎外科手术治疗提供了科学依据,是一种全面准确的致灶评估方法。
关键词:  局灶性脑发育不良  多模态癫评估体系  难治性癫  预后
DOI:10.16781/j.0258-879x.2019.12.1378
投稿时间:2019-06-19修订日期:2019-11-01
基金项目:兰州大学第二医院萃英科技创新项目(CY2018-BJ12).
Application of multimodal epilepsy assessment system in focal cortical dysplasia-related epilepsy
WU Hai-yang,SHI Zhe,SHEN Yun-juan,SHI Xue-feng,LAN Zheng-bo,HAN Yan-ming,ZHANG Xin-ding*
(Department of Neurosurgery, Laboratory of Neurosurgery, Institute of Neurology, Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China
*Corresponding author)
Abstract:
Objective To propose a multimodal epilepsy assessment system to guide the surgical treatment of patients with focal cortical dysplasia (FCD)-related epilepsy, and to explore its significance in improving the prognosis of patients with FCD-related epilepsy. Methods Twenty-two epilepsy patients with FCD confirmed by postoperative pathology, who underwent surgical treatment at Second Hospital of Lanzhou University from Oct. 2016 to Nov. 2018, were enrolled. All patients were evaluated by multimodal epilepsy assessment system during the perioperative period. The assessment techniques included onset symptom assessment, structural imaging, long-term scalp video electroencephalogram monitoring, positron emission tomography-computed tomography, image fusion analysis, and magnetic resonance imaging (MRI). Engel efficacy grading system was used to assess the prognosis. Engel Ⅰ grade was defined as good control for epilepsy and Engel Ⅱ to Ⅳ as poor control. Fisher exact test was used to explore the influences of gender, age, pathological type, MRI examination, lesion location, duration of disease, and electroencephalogram-clinical characteristic-anatomical localization consistency on the prognosis of patients. Results Twenty-two patients (13 males and 9 females) underwent surgical resection of the lesions, and were followed up for 4 to 28 months. There were 18 cases of Engel Ⅰ grade, 2 cases of Engel Ⅱ grade, 1 case of Engel Ⅲ grade, and 1 case of Engel Ⅳ grade, with the good control rate being 81.8% (18/22). Fisher exact test analysis showed that disease duration and electroencephalogram-clinical characteristic-anatomical localization consistency were independent factors of efficacy of FCD-related epilepsy (P=0.045 and 0.005). While age, lesion location, gender, pathological type and MRI findings had no significant effect on prognosis (all P>0.05). Conclusion The multimodal epilepsy assessment system can more accurately locate epileptogenic foci of patients with FCD-related epilepsy, providing a theoretical basis for epilepsy surgery. It is a comprehensive and accurate assessment method for epileptogenic foci.
Key words:  focal cortical dysplasia  multimodal epilepsy assessment system  refractory epilepsy  prognosis