1、Temporal plus epilepsy ( TPE ),周健 神經(jīng)外科 首都醫(yī)科大學(xué) 三博腦科醫(yī)院 中國(guó). 北京 2016.5,顳葉癲癇的手術(shù)療效,Of 168 patients included, 108 (63.7%) underwent stereoelectroencephalography, 131 (78%) had hippocampal sclerosis, 149 suffered from unilateral temporal lobe epilepsy (88.7%), one from bitemporal epilepsy (0.6%) and 18 (10.

2、7%) from temporal plus epilepsy. The probability of Engel class I outcome at 10 years of follow-up was 67.3% (95% CI: 63.471.2) for the entire cohort, 74.5% (95% CI: 70.678.4) for unilateral temporal lobe epilepsy, and 14.8% (95% CI: 5.923.7) for temporal plus epilepsy. Multivariate analyses demonst

3、rated four predictors of seizure relapse: temporal plus epilepsy (P0.001), postoperative hippocampal remnant (P = 0.001), past history of traumatic or infectious brain insult (P = 0.022), secondary generalized tonic-clonic seizures (P = 0.023).,顳葉附加癲癇的簡(jiǎn)介,The term of temporal plus (Tt) epilepsies has

4、 recently been suggested (Ryvlin and Kahane, 2005) to describe specific forms of seizures of multilobar origin which are characterized by the involvement of a complex epileptogenic network including the temporal lobe and the closed neighboured structures, such as the orbito-frontal cortex, the insul

5、a, the frontal and parietal operculum and the temporoparietooccipital junction. In a depth EEG study aiming at verifying the role of the perisylvian cortex in seizures involving the temporal lobe, Kahane et al. (2001) showed that six of the seven patients in whom seizures arose from temporal and sup

6、rasylvian opercular cortices, and in whom an adequate temporo-perisylvian resection could be achieved, were totally seizure-free after surgery.,Temporal lobe surgery alone was unsuccessful in the two temporo-insular cases of Isnard et al. (2004), since it allowed them to suppress the seizures of tem

7、poral lobe origin, but not those which arose from the insula. Moreover, anterior temporal resection did not benefit the patients with ictal temporo-parietal symptoms (reported by Aghakhani et al., 2004) Temporal lobectomy failed to control seizures in four of the six patients with posterior basal te

8、mporal ictal onset, reported by Prasad et al. (2003),癲癇外科的術(shù)前評(píng)估,Phase IHistory, Physical ,VEEG Monitoring Neuropsychology testing, Imaging ( CT,MRI, PET, SPECT, MRS, fMR) Phase IIIntracarotid Amytal Test ( WADA ),Phase IIIIntracranial Monitoring with a combination of depth, Strip, and Grid Electrodes

9、,癲癇外科的術(shù)前評(píng)估,Case discussion,Yuan M Female,26yrs R-handed,病例特點(diǎn)輔助檢查 頭皮腦電圖 頭顱MRI 頭PET 神經(jīng)心理評(píng)估顱內(nèi)電極置入,病例特點(diǎn),女性，26歲，右利手，病史14年 現(xiàn)病史： 12歲首次發(fā)作，主要表現(xiàn)為：GTCS，持續(xù)約1-2min緩解，此后一周內(nèi)出現(xiàn)2次類似癥狀，服用丙戊酸鈉后2年無(wú)發(fā)作； 目前發(fā)作類型：精神先兆（似曾相識(shí)感）言語(yǔ)自動(dòng)自動(dòng)運(yùn)動(dòng)（吞咽、雙手摸索）GTCS，發(fā)作后不能回憶發(fā)作過(guò)程 治療：丙戊酸鈉、拉莫三嗪 個(gè)人史：母孕期正常，足月順產(chǎn)，無(wú)生后缺氧窒息史；生長(zhǎng)發(fā)育正常 家族史：否認(rèn)類似家族史,Scalp EEG B

10、Ga -Yuan M,Scalp EEG SZ -Yuan M,Scalp EEG SZ continued-Yuan M,Scalp EEG SZ continued-Yuan M,Scalp EEG SZ continued-Yuan M,Scalp EEG SZ continued-Yuan M,Scalp EEG SZ continued-Yuan M,頭皮腦電圖,間歇期：未見(jiàn)典型癲癇樣放電 發(fā)作期：1.臨床：全身動(dòng)作減少自動(dòng)運(yùn)動(dòng) 植物神經(jīng)癥狀復(fù)雜運(yùn)動(dòng) 2.EEG：發(fā)作型，彌漫性，左側(cè)前頭部,輔助檢查,頭皮腦電圖 頭顱MRI 頭PET 神經(jīng)心理評(píng)估,輔助檢查,頭皮腦電圖 頭顱MRI 頭

11、PET 神經(jīng)心理評(píng)估,左側(cè)半球,左側(cè)半球： A 顳中回-杏仁核（16） B 顳中回-海馬頭（16） C 顳中回中部-海馬旁回（16） D 顳中回后部-海馬后部（16） E 顳上回-第2島長(zhǎng)回（12） F 顳極（12） J 額中回-第2-3島短回、第1島長(zhǎng)回（斜視16） L 角回-扣帶回（16） M 顳中回后部顳枕交界-顳底-海馬頭下方（斜插16） N 額上回-扣帶回-額底內(nèi)側(cè)面（斜插16） 右側(cè)半球 B 顳中回-海馬頭（16）,左側(cè)半球,左側(cè)半球： A 顳中回-杏仁核（16） B 顳中回-海馬頭（16） C 顳中回中部-海馬旁回（16） D 顳中回后部-海馬后部（16） E 顳上回-第2島長(zhǎng)回（12） F 顳極（12） J 額中回-第2-3島短回、第1島長(zhǎng)回（斜視16） L 角回-扣帶回（16） M 顳中回后部顳枕交界-顳底-海馬頭下方（斜插16） N 額上回-扣帶回-額底內(nèi)側(cè)面（斜插16） 右側(cè)半球 B 顳中回-海馬頭（16）,SEEG SZ onset-Yuan M,臨床：精神先兆（1/5）自動(dòng)運(yùn)動(dòng)植物神經(jīng)癥狀復(fù)雜運(yùn)動(dòng)（1/5）LOC EEG：