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Objective To explore the neural function analysis based on PET/CT imaging for the MRI negative localization in patients with refractory epilepsy.Methods 85 cases of drug refractory epilepsy patients (male 47,female 38,M/F:1.2 ︰ 1;age range from 6-35 years old),receiving head PET/CT conventional imaging in the interphase,compared to the normal PET cerebral metabolic databases.Surgery was carried out on the patients who with unilateral lobe of the brain,the efficacy was evaluated according to the Eagle standard.Results Epilepsy in unilateral was 63.5%(54/85 ),bilateral was 28.2%(24/85 )and unclear was 8.3%(7/85 ).6 months,12 months,18 months and 24 months later after surgery in patients who with unilateral lobe,the efficacy reaching the Eagle class Ⅰ and class Ⅱ standards was 61.1% (33/54),61.1% (33/54),61.1% (33/54),59.1% (29/49 ),respectively.Conclusion PET/CT neural function analysis could find epileptogenic zone which was negative in MRI imaging in patients with refractory epilepsy, is one of the important methods of preoperative localization.
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@#Objective To investigate the value of synthetic aperture magnetometry (SAM) in localizing motor cortex and epileptogenic focus for brain lesions near the central sulcus and to clear its advantage in the localization. Methods 12 patients (6 patients with epilepsy) were enrolled in this study. Before the operation, the patients were all taken Karnofsky Performance Status Score (KPS), examined with MEG by SAM technique in the localization of motor cortex and epileptogenic focus to determine their position relationship, and guide the scheme of surgery programme. During the operation, the location of hand-motor functional area were identified with evoked potential monitoring awaking test, and epileptogenic focus with electrocorticogram (ECoG) monitoring. The accuracy of location was assessed with the hand movement and KPS score, and the epileptic attack were evaluated with Engel curative effect grading. They were followed up for 2 years. Results The motor cortex of all the patients were located near the precentral gyrus with SAM and the localization of epileptogenic focus in 6 patients by SAM was consistent with that by ECoG. All the operations were based on and guided by the SAM. After the operations, the motor function and KPS score of 8 patients improved. No extra functional lesions happened in all patients. Epilepsy was well controlled in 5 cases. Conclusion SAM can correctly localize the motor cortex and epileptogenic focus. Meanwhile position relationship between the intracranial lesions and motor functional areas and epileptic focus can be clear. It is a valuable method for surgical planning and epilepsy controlling and will decrease the occurrence of neurological deficits after operation.
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We report a rare case of meningioangiomatosis in a 22 year-old man who has refractory partial seizures. Seven of 11 seizures had ictal onset zone at the perilesional medial and orbitofrontal areas of frontal lobe and 4 seizures arose from the mesial temporal area. After having lesion resection and an anterior temporal lobectomy with amygdalohippocam-pectomy, the patient no longer suffered from seizures. The epileptogenic foci were found not only in the intra-/peri-lesional area but also in remote area.
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Humans , Young Adult , Anterior Temporal Lobectomy , Epilepsy , Frontal Lobe , SeizuresABSTRACT
Objective To explore the significance of intra carotid arterial diazepam injection in lateralization of intractable epilepsy with bilateral synchronous epileptiform discharges. Methods Intra carotid arterial diazepam injection test was performed in 20 patients suffering from intractable epilepsy with bilateral synchronous epileptiform discharges under EEG monitoring. Side of the epileptogenic focus was determined by observation of the inhibition of epileptiform discharges after injection. Results After diazepam injection, disappearance of bilateral synchronous epileptiform discharges was found in 16 patients (80%), so the injection side was decided as the epilepogenic focus. Disappearance of the epileptiform discharges was found at the injection side, but disappearance of the bilateral epileptiform discharges was found after injection at the opposite side in 4 cases (20%). The accuracy of lateralization was proved by surgery, electrocorticography (EcoG), and depth electroencephalography (DEEG) in 12 out of the 20 cases. During the follow up for 1-6 5 years after surgery and gamma knife treatment, disappearance of clinical seizure and epileptiform discharges of EEG and improvement were found in 15 cases (75%) and 5 cases (25%), respectively. Conclusion Intra carotid arterial diazepam injection is of important clinical value in lateralization of the epileptogenic focus before surgery for patients with intractable epilepsy.
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From July of 1989 to January of 1991,we performed surgical operations on 20 cases with intractable epilepsy.The preoperative localization of epileptogenic foci was based on a comprehensive evaluation of patients'seizure history,scalp EEG,topographic EEG display, cranial electrode recording,CT and neuropsychological investigations.Then,we selected an adequate surgical treatment,including 1 case of hemispherectomy,10 cases of anterior tem- poral lobectomy and 8 cases of extratemporal resection of the epileptogenic focus.Detected by electrocorticography and electrical stimulation monitoring,16 postoperative cases(80%) had seizure free and 4 cases(20%)had a more than 50% reduction in seizure frequency. The localization of epileptogenic foci,and surgical method and effect were discussed in detail. The key of surgical selection is to exactly localize epileptogenic foci with a comprehensive evaluation of various recordings and studies.The intracranial electrode recording is important for the localization of an epileptogenic focus.
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This article reports the experience of treatment of 30 cases of temporal epilepsy with surgery. There were 15 male patients and 15 female. The duration of the disease ranged from 5 to 37 years with an average of 13.6 years. 12 patients suffered from grand and petite mal, 8 Jacksonian accompanied by psychomotor epilepsy, and 10 grand mal. Before the operation, the focus with sporadic spikes was found in the temporal lobe with electroencephalogram. Operation: the temporal pole and the medi-basal region were removed in 9 cases, anterior portion of the temporal nesiolobe in 10 cases, temporal neocortical of the temporal lobe in 6 cases, dorsolateral and laterobasal parts in 5 cases. Organic pathological changes were confirmed in all cases by pathological examination. Clinical result of all cases was satisfactory, with an effective rate of 93%. The clinical and pathological changes of epilepsy and efficacy of the treatment are discussed. It is stressed that the localization of the focus of epilepsy depe nds mainly on electroencephalogram. It is very important to look for sporadic spikes using cortical electrode during operation, and complete eradication of the focus is the key to achieve a good treatment effect.