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目的总结以过度运动发作为主要表现的药物难治性癫的诊疗经验。方法回顾性分析25例药物难治性癫病人的临床资料,均以过度运动发作为主要表现。根据症状特点、MRI、头皮视频脑电图及颅内脑电图监测,综合定位致灶,并行手术切除。结果切除额叶致灶23例,切除前颞叶致灶2例。神经病理学检查显示:皮质发育不良(FCD)Ⅰ型8例,FCDⅡ型12例,节细胞胶质瘤1例,皮质微发育不良1例,灰质异位1例,胶质瘢痕1例,海马硬化1例。术后随访12~60个月,按Engel分级:Ⅰ级19例,Ⅱ级2例,Ⅲ级2例,Ⅳ级2例。结论以过度运动发作为特点的难治性癫病人,其致灶主要位于额叶,但也可位于额叶外的脑区,准确切除致灶后疗效满意。
Objective To summarize the diagnosis and treatment of drug-refractory epilepsy with over-exercise as the main manifestation. Methods The clinical data of 25 patients with refractory epilepsy were retrospectively analyzed, all of which were characterized by over-exercise. According to the characteristics of symptoms, MRI, scalp video EEG and intracranial electroencephalogram monitoring, comprehensive positioning caused by foci, concurrent surgical resection. Results Excision of frontal cortex in 23 cases, removal of anterior temporal lobe in 2 cases. Neuropathological examination showed 8 cases of type Ⅰ cortical dysplasia (FCD), 12 cases of FCD Ⅱ type, 1 case of glioma of ganglion cells, 1 case of cortical microdosis, 1 case of ectopic gray matter, 1 case of glial scar, 1 case. The patients were followed up for 12 to 60 months. According to Engel classification, 19 cases were grade Ⅰ, 2 cases were Ⅱ, 2 cases were Ⅲ and 2 cases were Ⅳ. Conclusion The patients with refractory epilepsy characterized by over-exercise are mainly located in the frontal lobe, but may also be located outside the frontal lobe, and the curative effect is satisfactory after the excision of the foci.