颞叶附加癫痫.ppt

Temporalplusepilepsy(TPE),周健zhoujian5151神经外科首都医科大学三博脑科医院中国.北京2016.5,颞叶癫痫的手术疗效,Of168patientsincluded,108(63.7%)underwentstereoelectroencephalography,131(78%)hadhippocampalsclerosis,149sufferedfromunilateraltemporallobeepilepsy(88.7%),onefrombitemporalepilepsy(0.6%)and18(10.7%)fromtemporalplusepilepsy.TheprobabilityofEngelclassIoutcomeat10yearsoffollow-upwas67.3%(95%CI:63.471.2)fortheentirecohort,74.5%(95%CI:70.678.4)forunilateraltemporallobeepilepsy,and14.8%(95%CI:5.923.7)fortemporalplusepilepsy.Multivariateanalysesdemonstratedfourpredictorsofseizurerelapse:temporalplusepilepsy(P0.001),postoperativehippocampalremnant(P=0.001),pasthistoryoftraumaticorinfectiousbraininsult(P=0.022),secondarygeneralizedtonic-clonicseizures(P=0.023).,颞叶附加癫痫的简介,Thetermoftemporalplus(Tt)epilepsieshasrecentlybeensuggested(RyvlinandKahane,2005)todescribespecificformsofseizuresofmultilobaroriginwhicharecharacterizedbytheinvolvementofacomplexepileptogenicnetworkincludingthetemporallobeandtheclosedneighbouredstructures,suchastheorbito-frontalcortex,theinsula,thefrontalandparietaloperculumandthetemporoparietooccipitaljunction.InadepthEEGstudyaimingatverifyingtheroleoftheperisylviancortexinseizuresinvolvingthetemporallobe,Kahaneetal.(2001)showedthatsixofthesevenpatientsinwhomseizuresarosefromtemporalandsuprasylvianopercularcortices,andinwhomanadequatetemporo-perisylvianresectioncouldbeachieved,weretotallyseizure-freeaftersurgery.,Temporallobesurgeryalonewasunsuccessfulinthetwotemporo-insularcasesofIsnardetal.(2004),sinceitallowedthemtosuppresstheseizuresoftemporallobeorigin,butnotthosewhicharosefromtheinsula.Moreover,anteriortemporalresectiondidnotbenefitthepatientswithictaltemporo-parietalsymptoms(reportedbyAghakhanietal.,2004)Temporallobectomyfailedtocontrolseizuresinfourofthesixpatientswithposteriorbasaltemporalictalonset,reportedbyPrasadetal.(2003),癫痫外科的术前评估,PhaseIHistory,Physical,VEEGMonitoringNeuropsychologytesting,Imaging(CT,MRI,PET,SPECT,MRS,fMR)PhaseIIIntracarotidAmytalTest(WADA),PhaseIIIIntracranialMonitoringwithacombinationofdepth,Strip,andGridElectrodes,癫痫外科的术前评估,Casediscussion,YuanMFemale,26yrsR-handed,病例特点辅助检查头皮脑电图头颅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14年现病史：12岁首次发作，主要表现为：GTCS，持续约1-2min缓解，此后一周内出现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、双手摸索）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：否认类似家族史,ScalpEEGBGa-YuanM,ScalpEEGSZ-YuanM,ScalpEEGSZcontinued-YuanM,ScalpEEGSZcontinued-YuanM,ScalpEEGSZcontinued-YuanM,ScalpEEGSZcontinued-YuanM,ScalpEEGSZcontinued-YuanM,头皮脑电图,间歇期：未见典型癫痫样放电发作期：1.临床：全身动作减少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,辅助检查,头皮脑电图头颅MRI头PET神经心理评估,辅助检查,头皮脑电图头颅MRI头PET神经心理评估,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）,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