【摘要】：目的:通過分析難治性癥狀性癲癇患者病灶切除后皮層腦電圖(electrocorticography,ECoG)殘余癇樣放電類型[棘波、ripple、fast ripple(FR)]以及殘余數(shù)量,探討其與術(shù)后癲癇發(fā)作的關(guān)系。方法:回顧性分析重慶醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)外科2010年1月至2015年1月共71例經(jīng)外科切除性手術(shù)治療的難治性癥狀性癲癇患者資料�；颊咝g(shù)后隨訪時(shí)間1~5年。選取病灶切除后最后1次監(jiān)測(cè)1min無干擾的ECoG數(shù)據(jù)。根據(jù)各殘余癇樣放電類型,分別分析殘余棘波(1~40Hz,棘波組)、ripple(80~250Hz,R組)和FR(250~500Hz,FR組)3組觀測(cè)指標(biāo),再根據(jù)各組內(nèi)患者殘余事件有無分為陽(yáng)性(+)和陰性(-)亞組,比較各亞組內(nèi)術(shù)后癲癇發(fā)作患者的數(shù)量;并統(tǒng)計(jì)各組患者殘余事件的出現(xiàn)量,探討各類殘余癇樣放電類型以及數(shù)量與術(shù)后癲癇發(fā)作的關(guān)系。結(jié)果:71例患者平均隨訪(2.3±1.5)年,術(shù)后癲癇控制(EngelⅠa)45(63.38%)例,術(shù)后癲癇發(fā)作(EngelⅠb~Ⅳ)26(36.62%)例。各殘余事件組中:1.FR(+)患者術(shù)后癲癇發(fā)生顯著高于FR(-)患者(12/17 vs 14/54,P0.01),殘余FR對(duì)術(shù)后癲癇發(fā)作陽(yáng)性預(yù)測(cè)值(positive predictive value,PPV)為70.59%,陰性預(yù)測(cè)值(negative predictive value,NPV)為74.07%;術(shù)后癲癇發(fā)作患者平均FR數(shù)量顯著高于術(shù)后癲癇控制患者[(7.62±1.19)vs(5.24±1.30),P0.01]。2.R(+)患者術(shù)后癲癇發(fā)生高于R(-)患者(19/44 vs 7/27,P=0.14),殘余R對(duì)術(shù)后癲癇PPV為43.18%,NPV為74.07%;術(shù)后癲癇發(fā)作患者平均R數(shù)量高于術(shù)后癲癇控制患者[(9.39±4.01)vs(8.06±3.09),P=0.13]。3.棘波(+)患者術(shù)后癲癇發(fā)生高于棘波(-)患者(21/52 vs 5/19,P=0.28),殘余棘波對(duì)術(shù)后癲癇發(fā)作PPV為40.38%,NPV為73.68%;術(shù)后癲癇發(fā)作患者平均棘波數(shù)量高于術(shù)后癲癇控制患者[(14.38±5.82)vs(13.81±4.62),P=0.23]。結(jié)論:難治性癥狀性癲癇患者病灶切除后ECo G殘余的FR可能是術(shù)后癲癇發(fā)作的電生理標(biāo)識(shí),且殘余FR量較高時(shí)與術(shù)后癲癇發(fā)作關(guān)系更為密切。
[Abstract]:Objective: to investigate the relationship between residual epileptiform ripple (FR) and postoperative epileptic seizures in patients with intractable symptomatic epilepsy by analyzing the type of residual epileptiform discharge (ECoG) in patients with intractable symptomatic epilepsy. Methods: the data of 71 patients with refractory symptomatic epilepsy treated by surgical resection from January 2010 to January 2015 were retrospectively analyzed in the Neurosurgery Department of the first affiliated Hospital of Chongqing Medical University. The patients were followed up for 1 ~ 5 years. The ECoG data of 1min were monitored for the last time after resection. According to the type of residual epileptiform discharge, the three groups of residual spike wave (1 ~ 40 Hz, spike wave group) and FR (250 ~ 500 Hz ~ (-1) FR group) were analyzed respectively, and then according to whether the residual events were positive (-) or negative (-) in each group, To compare the number of patients with postoperative epileptic seizures in each subgroup, and to count the occurrence of residual events in each group, and to explore the relationship between the types of residual epileptiform discharge and the number of epileptic seizures after operation. Results 71 cases were followed up for an average of (2.3 鹵1.5) years, 45 cases (63.38%) of postoperative epilepsy control (Engel 鈪，

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