您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (10): 82-88.doi: 10.6040/j.issn.1671-7554.0.2021.0456

• 临床医学 • 上一篇    下一篇

立体定向脑电图引导下射频热凝毁损术治疗药物难治性癫痫的有效性分析

贾建华,陈思,吴倩倩,徐硕,李超,程莲,徐淑军   

  1. 山东大学齐鲁医院神经外科, 山东 济南 250012
  • 发布日期:2021-10-15
  • 通讯作者: 陈思. E-mail:chensi106@163.com

Efficacy of SEEG-guided radiofrequency thermocoagulation in patients with medically intractable epilepsy

JIA Jianhua, CHEN Si, WU Qianqian, XU Shuo, LI Chao, CHENG Lian, XU Shujun   

  1. Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2021-10-15

PDF (PC)

160

摘要： 目的 分析立体定向脑电图(SEEG)引导下射频热凝毁损术对于治疗药物难治性癫痫的有效性。 方法 将山东大学齐鲁医院癫痫诊疗中心2018年11月至2020年11月收治的14例药物难治性癫痫患者作为研究对象,通过SEEG明确致痫灶,对致痫灶实施SEEG引导下的射频热凝毁损术,分析其有效性及安全性。 结果 14例患者共植入143根电极,根据SEEG结果共热凝50根电极。14例患者热凝后随访2~25个月,平均(8.29±7.90)个月,2例(14.30%)患者术后分别随访3个月及6个月,癫痫无发作为EngelⅠ级;4例(28.57%)患者术后平均随访(3.75±0.50)个月,癫痫发作减少90%以上为EngeⅢ级;5例(35.71%)患者术后平均随访(8.00±6.32)个月,癫痫发作减少50%以上为Engel Ⅲ级;2例(14.30%)患者术后随访25个月癫痫发作减少不足50%,1例(7.10%)热凝后随访2个月发作基本同术前为Engel Ⅳ级。14例患者热凝前后发作频率差异有统计学意义(P=0.001 7),且热凝后的效果随着时间的延长而减退。14例患者热凝后均未出现永久性功能损害。 结论 SEEG引导下的射频热凝毁损术对药物难治性癫痫是一种安全、有效的疗法,影响其有效性的因素较多,它可以有效预测切除手术疗效,对特定类型的癫痫病灶可作为治疗的主要选择。

关键词: 立体定向脑电图, 射频热凝毁损术, 药物难治性癫痫, 有效性

Abstract: Objective To analyze the efficacy of radiofrequency thermocoagulation(RF-TC)guided by stereoelectroencephalography(SEEG)in patients with medically intractable epilepsy. Methods A total of 14 patients treated in our hospital during Nov. 2018 and Nov. 2020 were enrolled. Epileptogenic zones were located with SEEG, and RF-TC was performed on the epileptogenic zones. The efficacy and safety were evaluated. Results Altogether 143 electrodes were implanted, and 50 electrodes were radiofrequency thermocoagulated according to the SEEG localization results. Patients were followed up for 2 to 25 months after treatment, with a mean of(8.29±7.90)months. Two cases(14.30%)were followed up for 3 and 6 months respectively, seizure-free, classified as Engel Ⅰ; 4 cases(28.57%)were followed up with a mean of(3.75±0.50)months, and their seizures decreased by more than 90%, classified as Engel Ⅱ; 5 cases(35.71%)were followed up for a mean of(8.00±6.32)months, and their seizures decreased by more than 50%, classified as Engel Ⅲ; 2 cases(14.30%)were followed up for 25 months, and their seizures decreased by less than 50%; 1 case(7.10%)was followed up for 2 months, and the seizure was the same as that before treatment, classified as Engel Ⅳ. There was statistical significance in the frequency of seizure before and after thermocoagulation in all cases(P=0.0017), and the efficacy of thermocoagulation declined with time. No permanent functional impairment was observed. Conclusion SEEG-guided radiofrequency thermocoagulation is a safe and effective treatment for medically intractable epilepsy, but there are many factors that affect its efficacy. It can effectively predict the curative effect of surgical resection and can be used as the main treatment option for specific types of epileptic lesions.

Key words: Stereoelectroencephalography, Radiofrequency thermocoagulation, Intractable epilepsy, Efficacy

中图分类号: 

  • R742.1
[1] Bartolomei F, Lagarde S, Wendling F, et al. Defining epileptogenic networks: Contribution of SEEG and signal analysis [J]. Epilepsia, 2017, 58(7): 1131-1147.
[2] Mullin JP, Shriver M, Alomar S, et al. Is SEEG safe? a systematic review and meta-analysis of stereo-electroencephalography-related complications [J]. Epilepsia, 2016, 57(3): 386-401.
[3] Gonzalez-Martinez J, Bulacio J, Alexopoulos A, et al. Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center [J]. Epilepsia, 2013, 54(2): 323-330.
[4] Guenot M, Isnard J, Ryvlin P, et al. SEEG-guided RF thermocoagulation of epileptic foci: feasibility, safety, and preliminary results [J]. Epilepsia, 2004, 45(11): 1368-1374.
[5] Cossu M, Fuschillo D, Casaceli G, et al. Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases [J]. J Neurosurg, 2015, 123(6): 1358-1367.
[6] Bourdillon P, Isnard J, Catenoix H, et al. Stereo electroencephalography-guided radiofrequency thermocoagulation(SEEG-guided RF-TC)in drug-resistant focal epilepsy: Results from a 10-year experience [J]. Epilepsia, 2017, 58(1): 85-93.
[7] Chassoux F, Navarro V, Catenoix H, et al. Planning and management of SEEG [J]. Neurophysiol Clin, 2018, 48(1): 25-37.
[8] Gotman J. Not just where, but how does a seizure start? [J]. Epilepsy Curr, 2019, 19(4): 229-230.
[9] Lagarde S, Buzori S, Trebuchon A, et al. The repertoire of seizure onset patterns in human focal epilepsies: determinants and prognostic values [J]. Epilepsia, 2019, 60(1): 85-95.
[10] Bartolomei F, Nica A, Valenti-Hirsch MP, et al. Interpretation of SEEG recordings [J]. Neurophysiol Clin, 2018, 48(1): 53-57.
[11] Hoppe C, Witt JA, Helmstaedter C, et al. Laser interstitial thermotherapy(LiTT)in epilepsy surgery [J]. Seizure, 2017, 48: 45-52. doi: 10.1016/j.seizure.2017.04.002.
[12] Quadri SA, Waqas M, Khan I, et al. High-intensity focused ultrasound: past, present, and future in neurosurgery [J]. Neurosurg Focus, 2018, 44(2): E16.
[13] Bourdillon P, Cucherat M, Isnard J, et al. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: a systematic review and meta-analysis [J]. Epilepsia, 2018, 59(12): 2296-2304.
[14] Zhao Q, Shi T, Cui S, et al. Stereotactic bilateral transfrontal minimal radiofrequency thermocoagulation of the amygdalohippocampal complex for bilateral medial temporal lobe epilepsy: a retrospective study of 12 patients [J]. Epileptic Disord, 2017, 19(2): 152-165.
[15] Mirandola L, Mai RF, Francione S, et al. Stereo-EEG: diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies [J]. Epilepsia, 2017, 58(11): 1962-1971.
[16] Dimova P, De Palma L, Job-Chapron AS, et al. Radiofrequency thermocoagulation of the seizure-onset zone during stereoelectroencephalography [J]. Epilepsia, 2017, 58(3): 381-392.
[17] Luo H, Zhao Q, Tian Z, et al. Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy [J]. Epilepsia, 2013, 54(11): 155-158.
[18] Andermann E, Andermann F, Dubeau F, et al. Periventricular nodular heterotopia [J]. Neurology, 1994, 44(3 Pt 1): 581-582.
[19] Dubeau F, Tampieri D, Lee N, et al. Periventricular and subcortical nodular heterotopia. a study of 33 patients [J]. Brain, 1995, 118( Pt 5):1273-1287.
[20] Moles A, Guenot M, Rheims S, et al. SEEG-guided radiofrequency coagulation(SEEG-guided RF-TC)versus anterior temporal lobectomy(ATL)in temporal lobe epilepsy [J]. J Neurol, 2018, 265(9): 1998-2004.
[21] 徐成伟, 周文静, 柏建军, 等. 立体定向脑电图引导射频热凝在难治性颞叶癫痫中的应用 [J]. 中华医学杂志, 2018, 98(13): 1008-1012. XU Chengwei, ZHOU Wenjing, BO Jianjun, et al. Application of stereoscopic electroencephalogram guided radiofronous thermocoagulation in refractory temporal lobe epilepsy [J]. Chin J Med, 2018, 98(13): 1008-1012.
[22] Cossu M, Fuschillo D, Cardinale F, et al. Stereo-EEG-guided radio-frequency thermocoagulations of epileptogenic grey-matter nodular heterotopy [J]. J Neurol Neurosurg Psychiatry, 2014, 85(6): 611-617.
[23] Liu Y, Zhou W, Hong B, et al. Multiple Stereoelectroencephalography-Guided Radiofrequency Thermocoagulations for Polymicrogyria with Startle Seizures: A Case Report [J]. Front Neurol, 2019, 10: 1095.
[24] Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography(SEEG)[J]. Neurophysiol Clin, 2018, 48(1): 5-13.
[25] Catenoix H, Mauguiere F, Guenot M, et al. SEEG-guided thermocoagulations: a palliative treatment of nonoperable partial epilepsies [J]. Neurology, 2008, 71(21): 1719-1726.
[1] 马翔,赵飞燕. 卵子冷冻保存现状与进展[J]. 山东大学学报 (医学版), 2022, 60(9): 19-23.
[2] 王丽丽,霍彬,王磊,汪浩,侯定坤,霍小东,王金焕,臧立,曹强,柴树德,王海涛. 亚肺叶切除联合125I粒子植入治疗早期肺癌有效性的Meta分析与系统评价[J]. 山东大学学报（医学版）, 2017, 55(10): 76-83.
[3] 李红专1，钱秋海2，钱卫斌2，武文广2，郭春芳2，蔡欣蕊2. 糖肝康方对糖尿病脂肪肝患者的治疗作用及其对血清瘦素水平的影响[J]. 山东大学学报(医学版), 2012, 50(4): 10-.
[4] 侯新国，周克华，甄晓慧，宋君，张亮，矫磊，陈丽. 重组人胰高血糖素样肽-1联合二甲双胍治疗2型糖尿病的有效性和安全性评价[J]. 山东大学学报(医学版), 2011, 49(11): 1-.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 黄飞,王怀经,邢毅,高薇,李永刚,邢子英,李振中. NGF和GM1联合应用对坐骨神经损伤大鼠初级传入神经元的保护作用[J]. 山东大学学报(医学版), 2006, 44(4): 332 -335 .
[2] 李洧,李道卫,叶茜,高顺翠,姜淑娟. 经支气管镜针吸活检在纵隔疾病诊断中的价值[J]. 山东大学学报(医学版), 2008, 46(11): 1063 -1065 .
[3] 吕龙飞,李林,李树海,亓磊,鲁铭,程传乐,田辉. 腔镜下细针导管空肠造瘘在微创McKeown食管癌切除术中的应用[J]. 山东大学学报 (医学版), 2020, 1(7): 77 -81 .
[4] 邵海港, 王璇, 王青. 山东地区人下颌第一前磨牙根管系统解剖研究[J]. 山东大学学报（医学版）, 2014, 52(9): 85 -89 .
[5] 刘海春 张剑锋 陈允震. 骨质疏松大鼠股骨生物力学特性与骨胶原质量变化的相关研究[J]. 山东大学学报(医学版), 2009, 47(5): 42 -45 .
[6] 冯复利1，魏树珍2，张永欢3，李莉1，陈融1，李瑞峰1. 胰岛素抵抗大鼠高死亡率与Klotho表达关系的研究[J]. 山东大学学报(医学版), 2010, 48(6): 5 -8 .
[7] 王旭平,赵玲,冯玉新,商林珊,刘金成,曹伟朋,朱晓音,辛华. 绞股蓝总苷对谷氨酸诱导的胎鼠大脑皮层神经元氧化性损伤保护机制的研究[J]. 山东大学学报(医学版), 2006, 44(6): 564 -567 .
[8] 王学萍,杨洪玲. 洛汀新治疗高血压50例报告[J]. 山东大学学报(医学版), 2007, (2): 213 .
[9] 黄圣运,张东升,张世周,刘桂军,赵跃然,王来成,刘义庆 . 重组表达载体pIRES-CD、pIRES-TK的构建及其在ACC-2细胞中的表达[J]. 山东大学学报(医学版), 2007, 45(2): 117 -123 .
[10] 唐芳1,2 ，张颖倩3 ，王志强4 ,康殿民4 ,王洁贞1 ,薛付忠1 . 自然疫源性疾病疫源地空间结构的二维
最小生成树模型及其应用
[J]. 山东大学学报(医学版), 2009, 47(01): 106 -110 .
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发