ELECTROPHYSIOLOGICAL CORRELATES OF PATHOLOGY AND SURGICAL RESULTS IN TEMPORAL-LOBE EPILEPSY
ELECTROPHYSIOLOGICAL CORRELATES OF PATHOLOGY AND SURGICAL RESULTS IN TEMPORAL-LOBE EPILEPSY
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DOI：
10.1093/brain/98.1.129
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发表时间：
1975-01-01
期刊：
影响因子：
14.5
通讯作者：
FALCONER, MA
中科院分区：
文献类型：
--
作者：
ENGEL, J;DRIVER, MV;FALCONER, MA
对59例接受标准单侧前颞叶切除术治疗癫痫的患者进行了常规的术前脑电图检查以及手术期间进行的直接脑记录和刺激。本系列中的所有患者在手术时均为16岁或以上，手术总是仅在局部头皮镇痛下进行。电生理检查结果与切除的颞叶中观察到的病理变化以及手术对癫痫发作活动的影响相关。术前EEG数据与四种病理类型中的每一种相关，当使用蝶骨电极和静脉注射巴比妥类麻醉剂时。31例颞叶内侧硬化症患者中有30例表现为颞叶内侧原发性棘波灶，常伴有独立的对侧和颞外继发灶。此外，三分之一的患者表现出相应的蝶骨至耳通道中巴比妥酸盐诱导的单侧局灶性快速活动减少。12例有其他特殊内侧局灶性病变（大多数为错构瘤）的患者也有颞内侧原发灶，通常有独立的对侧继发灶，但从未有颞外病灶。该组中的2例患者还表现出适当的蝶骨-耳通道中的局灶性快速活动减少。这两组患者在术后癫痫方面表现良好。5例大颞凸瘢痕早于癫痫发作的患者均表现出颞侧原发性棘波灶，无独立的继发性灶或局灶性快速活动减少，术后表现不如前两组。11名患者的切除颞叶仅出现非特异性变化，总体上并未从手术中受益。观察到原发性和独立的继发性棘波灶的各种组合。只有这一组表现出弥漫性或双额叶棘波在初始脑电图记录，和基础中线尖峰静脉硫喷妥钠。在这组中，佩西拉尔尖锐的锯齿波也很常见，但不是唯一的。巴比妥酸盐诱导的快速活动的局灶性减少没有注意到。
Routine pre-operative EEG studies as well as direct brain recording and stimulation carried out during operations were analysed for 59 patients subjected to a standard unilateral anterior temporal lobectomy for the treatment of epilepsy. All patients in the present series were 16 years old or older at the time of operation, which was invariably carried out under local scalp analgesia only. Electrophysiological findings was correlated with pathological changes noted in the resected temporal lobes, and with the effects of surgery upon seizure activity. Pre-operative EEG data correlated with each of four pathological categories when sphenoidal electrodes and intravenous barbiturate narcosis were emplyed. Thirty of 31 patients with mesial temporal sclerosis demonstrated medial temporal primary spike foci, frequently with independent contralateral and extratemporal secondary foci. In addition, one-third of these patients demonstrated unilateral focal decreased barbiturate-induced fast activity in the corresponding sphenoidal to ear channels. Twelve patients with other specific medial focal lesions (mostly hamartomas) also had medial temporal primary foci, often with independent contralateral secondaries but never with extratemporal foci. Two patients in this group also demonstrated focal decreased fast activity in the appropriate sphenoidal-ear channel. Both of these groups did very well post-operatively with respect to their epilepsy. Five patients with large temporal convexity cicatrices antedating seizures all demonstrated lateral temporal primary spike foci without independent secondary foci or focal decreased fast activity and did not do as well post-operatively as the first two groups. Eleven patients had only non-specific changes in the resected temporal lobe and in general did not benefit from surgery. Various combinations of primary and independent secondary spike foci were seen. Only this group demonstrated diffuse or bifrontal spikes during initial EEG recording, and basal mid-line spikes with intravenous thiopentone. Pecilar sharp notched spike were also very common in this group, but not unique to it. Focal decreases in barbiturate-induced fast activity were not noted.