Objective To investigate the effectiveness and safety of stereoelectroencephalography (SEEG) in guiding surgical treatment of temporal-insular type of temporal plus epilepsy (TI-TPE).Methods A retrospective analysis was conducted on the clinical data of 10 TI-TPE cases confirmed by SEEG from May 2014 to November 2015 at Department of Epilepsy Center,Guangdong Sanjiu Brain Hospital.Those 10 patients accounted for 6.8％ of 147 surgical cases of temporal lobe epilepsy treated during the same period.Electrodes were implanted in all cases with the assistance of neurosurgical stereotactic robot.The epileptogenic zone,including the anterior temporal lobe,mesial temporal lobe and epileptic insular cortex,were surgically resected with SEEG guidance.The outcome was assessed to explore the effectiveness of operation.Results The number of electrodes implanted in each case was 9-16 (12.4 ±2.1) on average.Based on the SEEG results,7 cases were classified as simultaneous type and 3 as independent type.All cases underwent surgical operations.No complication was observed in this series except for 1 who had transient naming aphasia and recovered before discharge.As indicated by clinical follow-up of 18-36 (28 ±6) months on average,all cases reached Engel class Ⅰ post operation (9 cases of Ⅰa and 1 of Ⅰc).Conclusion SEEG is a significant method for the diagnosis of TI-TPE.For TI-TPE cases,surgical treatment with the guidance of SEEG seems safe and effective.

Objective To observe the drug response of patients with benign temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and to summarize the clinical characteristics of patients with good drug response. Methods A total of 46 benign TLE-HS patients who were treated by anti-epileptic drugs (AEDs) and followed-up for at least 2 years with seizure-free periods longer than 12 months were enrolled in benign TLE-HS group and 51 AEDs-resistant patients were enrolled in control group. Demographic data, early sudden damage factor, family history of epilepsy, clinical symptoms, interictal EEG abnormality, side of hippocamal sclerosis and drug strategy were noted and compared between 2 groups. Multivariate forward Logistic regression was used to analyze the influencing factors of good drug response to TLE-HS. Results Age of onset (P = 0.041), duration (P = 0.001), history of febrile seizure (P = 0.019), initial seizure frequency (P = 0.001) and drug strategy (P = 0.000) were statistically different between 2 groups. Age, sex, perinatal injury, encephalitis, traumatic brain injury (TBI), family history of epilepsy, status epilepticus (SE), cognitive impairment, mental disturbance, seizure type, aura, interictal EEG abnormality and side of hippocamal sclerosis were not statistically different between 2 groups (P > 0.05, for all). History of febrile seizure was risk factor for benign TLE-HS (OR = 3.405, 95%CI: 1.080-10.737; P = 0.037), while low initial seizure frequency (OR = 0.275, 95% CI: 0.100-0.758; P = 0.013) and monotherapy (OR = 0.135, 95% CI: 0.049-0.373; P = 0.000) were protective factors for good drug response. Conclusions Benign TLE - HS often occurs in late adolescence. In the early stage, seizure frequency is low and the occurrence of febrile seizure is rare. Monotherapy of carbamazepine or oxcarbazepine may achieve good therapeutic effect. DOI: 10.3969/j.issn.1672-6731.2016.10.012

Objective To investigate the application value of stereoelectroencephalography (SEEG) in the preoperative assessment of epilepsy surgery.Methods The clinical data of 78 patients with drug-refractory epilepsy assessed with SEEG before procedure at the Epilepsy Center,Guangdong 999 Brain Hospital from April 2014 to April 2015 were analyzed retrospectively.The noninvasive assessment was conducted first,and the SEEG electrode placement scheme was designed according to the clinical and imaging data,and then under the guidance of robotized stereotactic assistant (ROSA),the electrode implantation was completed.The SEEG monitoring was conducted in order to complete the resection of epileptogenic zone finally under the guidance of neuronavigation.Results Seventy-eight patients completed 81 SEEG electrode implantations (3 patients had additional electrode implantations),including 16 (20.5％) bilateral implantations.A total of 940 SEEG electrodes were implanted and the average number of implanted electrodes was 12.3 per case.Only 1 patient had an epidural hematoma in the electrode region,and other patients did not have the complications,such as serious hemorrhage,infection,cerebrospinal fluid leakage,electrode fraction or displacement.Seventy-six patients successfully completed the resection of epileptogenic zone,and 2 patients failed to undergo surgery.Fifty-nine patients were followed up for 6-18 months.The seizure control for Engel rating grades were grade Ⅰ in 47 cases (79.7％),grade]Ⅱ in 2 cases (3.4％),grade Ⅲ in 6 cases (10.2％),and grade Ⅳ in 4 cases (6.8％).In 51 patients with MRI positive,the Engel grade Ⅰ was in 42 cases (82.4％);in 8 patients with MRI negative,the Engel grade Ⅰ was in 5 cases.There was no significant difference in the seizure control rate between the 2 groups (P ＞ 0.05).Conclusion The surgical treatment of epilepsy under the guidance of SEEG is both safe and effective.

目的 脑炎后癫痫常成为药物难治性癫痫,但切除性手术疗效不容乐观.回顾性分析药物难治性脑炎后颞叶癫痫的分类,经立体定向脑电图(SEEG)明确致痫区,重点分析颞叶癫痫附加症的特点和不同类型脑炎后颞叶癫痫的手术治疗的短期预后,为选择适宜的手术侯选者提供依据.方法 顺序纳入2014年1月1日-2015年8月31日广东三九脑科医院收治的药物难治性脑炎后颞叶癫痫患者15例,经规范无创术前评估,包括头皮视频脑电图监测、症状学分析、颅脑磁光振成像(MRI),间歇期FDG-PET扫描和神经心理学评估,经多学科讨论决策进行立体定向颅内电极植入.由SEEG明确致痫区,并将患者分为颞叶癫痫组和颞叶癫痫附加症组.采用Fisher精确检验或t检验,重点分析症状学种类、颅脑MR1病变侧向性,间歇期FDG-PET与致痫区的关系,以及两组的临床特点和切除性手术后(随访时间6 ～18个月)的短期疗效.结果 15例患者中颞叶癫痫组8例(8/15,53.33％),其中颞叶内侧型6例(单侧5例,双侧1例),内外侧混合型1例,颞叶外侧型1例;颞叶癫痫附加症组7例(7/15,46.67％).两组在癫痫起病年龄(P =0.548)、病程(P =0.099)、脑炎年龄(P =0.385),症状学种类(P=0.315)、颅脑MRI病变侧向性(P=1.000)、间歇期FDG-PET低代谢侧向性(P=1.000)以及颅内电极植入的单双侧(P=0.619)等方面无统计学差异.切除性手术治疗后随访6～18个月,Engel Ⅰ级8例,Engel Ⅱ级2例,Engel Ⅲ级2例,Engel Ⅳ级3例.颞叶癫痫组5例(5/8,62.5％)达Engel Ⅰ级,颞叶癫痫附加症组3例(3/7,42.9％)达Engel Ⅰ级.结论 药物难治性脑炎后颞叶癫痫中单侧颞叶内侧型和颞叶癫痫附加症为常见类型.颞叶癫痫附加症与其他类型颞叶癫痫相比临床床上无明确差异,需经SEEG明确致痫区.单侧颞叶内侧型切除性手术疗效相对较好,颞叶癫痫附加症较差.