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目的:探讨抗癫癎药(AEDs)长期控制的颞叶癫癎患者发作期间应用单光子发射电子计算机断层扫描(SPECT)检查异常灌注灶的修复。方法:颞叶癫癎患者经AEDs、步长脑心通胶囊与尼莫地平治疗,并在两次发作间期行SPECT、长程视频脑电图(V-EEG)和CT/MRI检查。结果:44例癫癎患者平均年龄为25岁;平均病程为3.5年;44例患者中病因明确者为19例(家族史2例,围产期损伤1例,热性惊厥3例,颅脑损伤出血1例,颅脑外伤5例,脑膜脑炎3例,脑部手术2例,多病因2例)。癫癎发作控制平均为25个月。治疗前发作间期SPECT异常(颞叶和非颞叶)感兴趣区(ROI)为77.3%,长程V-EEG异常77.3%(其中癎样放电88.2%),治疗前CT/MRI异常47.7%。治疗后发作间期SPECT正常增加4.5%(P>0.05),异常灶减少8.3%(P>0.05);长程V-EEG正常增加27.3%(P<0.05),癎样放电减少53.3%(P<0.05);结论:长期控制的颞叶癫癎患者的异常灌注灶修复明显低于其他类型癫癎,防治重点应放在颞叶癫癎症状出现之前的继发性全身强直阵挛发作。
Objective: To investigate the repair of abnormal perfusion lesions by single photon emission computed tomography (SPECT) during the long-term control of temporal lobe epilepsy in patients with antiepileptic drugs (AEDs). Methods: Patients with temporal lobe epilepsy were treated with AEDs, Buchang Naoxintong Capsule and nimodipine. SPECT, V-EEG and CT / MRI were performed in the two episodes. Results: The average age of 44 epilepsy patients was 25 years. The average course of disease was 3.5 years. Among the 44 patients, the etiological factors were 19 (family history 2, perinatal 1, febrile seizure 3, 1 case of bleeding, 5 cases of traumatic brain injury, 3 cases of meningoencephalitis, brain surgery in 2 cases, multiple causes in 2 cases). Epileptic seizures control an average of 25 months. The areas of interest (ROI), 77.3% of SPECT abnormalities (temporal lobe and non-temporal lobe), 77.3% of long-term V-EEG abnormalities (88.2% of them were squamous discharge) before treatment, and 47.7% of pretreatment CT / MRI abnormalities. After treatment, SPECT increased by 4.5% (P> 0.05) and abnormal lesion decreased by 8.3% (P> 0.05). Long-term V-EEG increased by 27.3% 0.05) .Conclusion: Long-term control of temporal lobe epilepsy patients with abnormal perfusion repair was significantly lower than other types of epilepsy, prevention and treatment should focus on temporal lobe epilepsy symptoms before the emergence of the second tonic seizures.