癫痫杂志

癫痫杂志

双侧颞叶癫痫的外科治疗策略

查看全文

单侧颞叶癫痫(Unilateral temporal lobe epilepsy,UTLE)是最适合外科手术的对象之一,手术疗效已得到肯定。但是仍有部分颞叶癫痫患者术后发作控制不理想,可能与致痫灶为双侧颞叶起源或颞叶附加癫痫综合征等因素相关。其中双侧颞叶癫痫(Bilateral temporal lobe epilepsy,BTLE)是临床治疗的难题,常常药物疗效差,而又不被建议外科治疗。然而,目前BTLE的诊断标准、发病率、以及外科治疗策略等方面仍不明确。文章对BTLE的临床概念、发生率、形成机制、临床特点、诊断依据、神经心理学检查及外科手术策略进行分析、探讨。结果显示,基于头皮发作间期、发作期脑电图(EEG)判定BTLE并不可靠,经过颅内电极发作期EEG记录后,部分患者可以诊断为UTLE,接受手术切除后,效果满意;部分患者的颅内EEG记录显示癫痫发作具有明显的偏侧倾向,也可以考虑切除性手术。高频(EEG)监测、神经影像学检查及神经心理学检查对BTLE的诊断和治疗策略也有重要意义。

关键词: 双侧颞叶癫痫; 颅内电极; 手术

引用本文: 周晓霞, 遇涛. 双侧颞叶癫痫的外科治疗策略. 癫痫杂志, 2017, 3(5): 406-409. doi: 10.7507/2096-0247.20170063 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Spencer S, Huh L.Outcomes of epilepsy surgery in adults and children.The Lancet Neurology, 2008, 7(6): 525-537.
2. West S, Nolan SJ, Cotton J, et al. Surgery for epilepsy.The cochrane database of systematic reviews, 2015, 1(7): CD010541.
3. Didato G, Chiesa V, Villani F, et al. Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum.Seizure, 2015, 31(5): 112-119.
4. Aghakhani Y, Liu X, Jette N, et al. Epilepsy surgery in patients with bilateral temporal lobe seizures: a systematic review.Epilepsia, 2014, 55(12): 1892-1901.
5. Boling W, Aghakhani Y, Andermann F, et al. Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings.Journal of Neurology, Neurosurgery & Psychiatry, 2009, 80(5): 533-538.
6. Sirven JI, Malamut BL, Liporace JD, et al. Outcome after temporal lobectomy in bilateral temporal lobe epilepsy.Annals of neurology, 1997, 42(6): 873-878.
7. Hirsch LJ, Spencer SS, Spencer DD, et al. Temporal lobectomy in patients with bitemporal epilepsy defined by depth electroencephalography.Annals of neurology, 1991, 30(3): 347-356.
8. Hirsch LJ, Spencer SS, Williamson PD, et al. Comparison of bitemporal and unitemporal epilepsy defined by depth electroencephalography.Annals of neurology, 1991, 30(3): 340-346.
9. Chkhenkeli SA, Towle VL, Lortkipanidze GS, et al. Mutually suppressive interrelations of symmetric epileptic foci in bitemporal epilepsy and their inhibitory stimulation.Clinical neurology and neurosurgery, 2007, 109(1): 7-22.
10. So N, Gloor P, Quesney LF, et al. Depth electrode investigations in patients with bitemporal epileptiform abnormalities.Annals of neurology, 1989, 25(5): 423-431.
11. Holmes MD, Miles AN, Dodrill CB, et al. Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy.Epilepsia, 2003, 44(8): 1075-1079.
12. So N, Olivier A, Andermann F, et al. Results of surgical treatment in patients with bitemporal epileptiform abnormalities.Annals of neurology, 1989, 25(5): 432-439.
13. Soper HV, Strain GM, Babb TL, et al. Chronic alumina temporal lobe seizures in monkeys.Exp Neurol, 1978, 62(1): 99-121.
14. Engel J, JR, Crandall PH.Falsely localizing ictal onsets with depth EEG telemetry during anticonvulsant withdrawal.Epilepsia, 1983, 24(3): 344-355.
15. Margerison JH, Corsellis JA.Epilepsy and the temporal lobes.A clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes.Brain, 1966, 89(3): 499-530.
16. Sano K, Malamud N.Clinical significance of sclerosis of the cornu ammonis: ictal psychic phenomena.AMA archives of neurology and psychiatry, 1953, 70(1): 40-53.
17. Mouritze Dam A.Hippocampal neuron loss in epilepsy and after experimental seizures.Acta Neurol Scand, 1982, 66(6): 601-642.
18. Schulz R, Luders HO, Hoppe M, et al. Lack of aura experience correlates with bitemporal dysfunction in mesial temporal lobe epilepsy.Epilepsy Res, 2001, 43(3): 201-210.
19. Rehulka P, Dolezalova I, Janousova E, et al. Ictal and postictal semiology in patients with bilateral temporal lobe epilepsy.Epilepsy Behav, 2014, 41(12): 40-46.
20. Di Vito L, Maugui Re F, Catenoix H, et al. Epileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates.Epilepsy Res, 2016, 128(12): 73-82.
21. Zhang J, Liu Q, Mei S, et al. Identifying the affected hemisphere with a multimodal approach in MRI-positive or negative, unilateral or bilateral temporal lobe epilepsy.Neuropsychiatric disease and treatment, 2014, 10(1): 71-81.
22. Haegelen C, Perucca P, Chatillon CE, et al. High-frequency oscillations, extent of surgical resection, and surgical outcome in drug-resistant focal epilepsy.Epilepsia, 2013, 54(5): 848-857.
23. Cho JR, Koo DL, Joo EY, et al. Resection of individually identified high-rate high-frequency oscillations region is associated with favorable outcome in neocortical epilepsy.Epilepsia, 2014, 55(11): 1872-1883.
24. Liu C, Zhang R, Zhang G, et al. High frequency oscillations for lateralizing suspected bitemporal epilepsy.Epilepsy Res, 2016, 127(11): 233-240.
25. Langfitt JT, Westerveld M, Hamberger MJ, et al. Worsening of quality of life after epilepsy surgery: effect of seizures and memory decline.Neurology, 2007, 68(23): 1988-1994.
26. King D, Spencer SS, Mccarthy G, et al. Bilateral hippocampal atrophy in medial temporal lobe epilepsy.Epilepsia, 1995, 36(9): 905-910.
27. Vogt VL, Witt JA, Malter MP, et al. Neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis.J Neurosurg, 2014, 121(5): 1247-1256.
28. Chung MY, Walczak TS, Lewis DV.Temporal lobectomy and independent bitemporal interictal activity: what degree of lateralization Is sufficient.Epilepsia, 1991, 32(2): 195-201.