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目的探讨双侧丘脑前核电刺激术治疗药物难治性癫的效果及其发生机制。方法共3例药物难治性癫患者行双侧丘脑前核电刺激术治疗,手术前后记录癫发作频率、发作类型、抗癫药物种类和剂量,以及影像学和脑电图结果。结果例1术后随访28个月,仅在漏服抗癫药物情况下出现1次发作,复查视频脑电图,偶见单个棘-慢复合波,发作控制率达100%。例2术后随访24个月,复查视频脑电图,发作间期呈右侧额区-中央区-顶区慢波,发作频率减少25%。例3术后随访3个月,复查视频脑电图,发作间期弥漫性棘-慢复合波减少,双侧枕区棘-慢复合波,发作频率减少55%。3例患者术后抗癫药物种类和剂量不变。结论脑深部电刺激术是治疗药物难治性癫的有效方法,可以明显减少发作频率或完全控制发作,从而改善患者生活质量。
Objective To investigate the effect and mechanism of bilateral thalamic nucleus electric stimulation on refractory epilepsy. Methods A total of 3 patients with drug refractory epilepsy were treated with bilateral thalamic nucleus electric stimulation before and after surgery. The frequency of epileptic seizures, the type of seizures, the types and doses of antiepileptic drugs, and the imaging and electroencephalogram results were recorded. Results Example 1 After 28 months of follow-up, only one episode occurred when the antiepileptic drug was missed. The video EEG was reviewed and a single spina-slow composite was occasionally found. The rate of seizure control was 100%. Example 2 After 24 months of follow-up, video EEG review, the right frontal seizure interval - the central area - the top of the slow wave, the seizure frequency decreased by 25%. Cases 3 were followed up for 3 months, video EEG review, interictal diffuse diffuse spine - slow complex wave reduction, both sides of the occipital spine - slow wave, seizure frequency decreased by 55%. 3 patients after antiepileptic drug type and dose unchanged. Conclusion Deep brain stimulation is an effective method for the treatment of refractory epilepsy. It can significantly reduce the frequency of seizures or completely control the seizure, thus improving the quality of life of patients.