Résumé
Objective:To explore the clinical characteristics, diagnostic methods, treatment strategies, and curative efficacies of epilepsy secondary to cerebral sparganosis.Methods:A retrospective analysis on clinical data of 62 patients with epilepsy caused by cerebral sparganosis diagnosed in our hospital from July 2004 to May 2019 was performed. According to the treatment intention of the patients, these patients were divided into surgery group ( n=39) and drug deworming group ( n=23). Patients in the surgery group were treated with craniotomy assisted by navigation to remove worms and lesions, and patients without live worms were treated with lesion resection or cortical burning. Patients in the drug deworming group were treated with praziquantel at a dose of 60 mg/(kg·d) with 10 d as a course of treatment; the next course of treatment was followed at an interval of 2 months, and ended until the standard of cure was achieved. All patients were followed up for 1-8 years, and the prognoses were determined according to the imaging data, clinical symptom improvement and sparganosis antibody IgG detection results. The epilepsy control 1 year after treatment was assessed by modified Engel grading. Results:Live worms were removed from 34 patients of the surgery group, with a total of 35 worms; after 1-8 years of follow-up, 34 patients were cured and 5 patients were not cured in the surgery group; however, 7 patients were cured and 16 patients were not cured in the drug deworming group; the cure rate in the surgery group was signficantly higher than that in the drug deworming group ( P=0.000). Modified Engel grading I was achieved in 36 patients, grading II in 2 patients, grading III in 0, and IV in 1 patient of the surgery group; modified Engel grading I was achieved in 9 patients, grading II in 3, grading III in 5, and grading IV in 6 patients of the drug deworming group; significant differences were noted between the two groups ( Z=203.000, P=0.000); the mean rank suggested that the surgery group had better efficacy than the drug deworming group(25.21 vs. 42.17). Conclusion:The successful surgical removal of live worms with the help of modern neurosurgery technology has better efficacy than drug deworming treatment in the epilepsy secondary to cerebral sparganosis.
Résumé
Objective To discuss the experience of surgical treatment for cerebral sparganosis and analyze the factors affecting the removal of live worms.Methods A retrospective analysis was performed on clinical data and treatment experience of 49 patients with cerebral sparganosis,admitted to and accepted surgery in our hospital from January 2001 to December 2017.These patients were divided into two groups according to whether the live worms were removed during the operation,namely live worms removal group and live worms non-removal group;factors affecting the removal of live worms were analyzed.Results A total of 36 live worms were removed from 49 patients,one of them took out two live worms in the same lesion.In 45 patients with seizures before surgery,39 of them had seizure-flee after surgery (Engel grading I).Re-examination MR imaging showed that lesions disappeared and no new lesions were found in the brains of the 39 patients.Another two with original lesion enhancement had shadow disappearance;however,new lesions appeared behind the lesion;one of them was re-operated in the contralateral temporal lobe of the original lesion,and the other one continued follow-up observation.No new hemorrhage lesion,infarction or meningitis after operation was noted in all patients.Statistical analysis showed that there were significant differences in times from lesion discovery to surgery and lesion locations between patients of the live worms removal group and the live worms non-removal group (P＜0.05).Conclusions Surgical treatment of cerebral sparganosis is safe and effective.Surgical treatment should be performed as soon as possible after the lesion is discovered.The times from lesion discovery to operation should be shortened to prevent the displacement of the worms.At the same time,it is necessary to select the specific surgical plan and timing of surgery in combination with lesion location to improve removal rate of live insects and reduce surgical complications.If necessary,surgery can be performed again.
Résumé
Objective To investigate the value of high frequency magnetoencephalography signals in the localization of refractory temporal lobe epilepsy. Methods Retrospective analysis was performed in 10 patients with refractory temporal lobe epilepsy admitted to and accepted surgery in our hospital from January 2015 to December 2015. Surgical approaches of these patients were determined according to the results of long-term video EEG monitoring (VEEG), MR imaging, and conventional and high-frequency magnetoencephalography (MEG). MEG positioning analysis was performed after the surgery; followed up for 12 months was performed to evaluate the surgical efficacies. Results The surgery was effective in all the 10 patients; 5 patients achieved Engel grading Ⅰ, 2 patients achieved Engel grading Ⅱ, and 3 patients achieved Engel grading Ⅲ. The results of high-frequency MEG analysis indicated that 8 lesions were consistent with the surgical sites, enjoying good results; while the positioning error of the 2 patients was large. Conclusions The localization analysis of high-frequency neuromagnetic signals has the potential to determine epileptogenic zones preoperatively for epilepsy surgery. High-frequency oscillation is a new biomarker for the diagnosis of epilepsy.