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1、颞叶附加癫痫颞叶附加癫痫的简介Thetermoftemporal‘plus’(Tt)epilepsieshasrecentlybeensuggested(RyvlinandKahane,2005)todescribespecificformsofseizuresofmultilobaroriginwhicharecharacterizedbytheinvolvementofacomplexepileptogenicnetworkincludingthetemporallobeandtheclosedneighbouredstructures,suchastheorbito
2、-frontalcortex,theinsula,thefrontalandparietaloperculumandthetemporo–parieto–occipitaljunction.InadepthEEGstudyaimingatverifyingtheroleoftheperisylviancortexinseizuresinvolvingthetemporallobe,Kahaneetal.(2001)showedthatsixofthesevenpatientsinwhomseizuresarosefromtemporalandsuprasylvianope
3、rcularcortices,andinwhomanadequatetemporo-perisylvianresectioncouldbeachieved,weretotallyseizure-freeaftersurgery.Temporallobesurgeryalonewasunsuccessfulinthetwotemporo-insularcasesofIsnardetal.(2004),sinceitallowedthemtosuppresstheseizuresoftemporallobeorigin,butnotthosewhicharosefromthe
4、insula.Moreover,anteriortemporalresectiondidnotbenefitthepatientswithictaltemporo-parietalsymptoms(reportedbyAghakhanietal.,2004)Temporallobectomyfailedtocontrolseizuresinfourofthesixpatientswithposteriorbasaltemporalictalonset,reportedbyPrasadetal.(2003)癫痫外科的术前评估PhaseI—History,Physical,V
5、EEGMonitoringNeuropsychologytesting,Imaging(CT,MRI,PET,SPECT,MRS,fMR)PhaseII—IntracarotidAmytalTest(WADA)PhaseIII—IntracranialMonitoringwithacombinationofdepth,Strip,andGridElectrodes癫痫外科的术前评估CasediscussionYuanMFemale,26yrsR-handed病例特点 辅助检查 头皮脑电图头颅MRI头PET神经心理评估 颅内电极置入病例特点女性，26岁，右利手，病史14年现
6、病史：12岁首次发作，主要表现为：GTCS，持续约1-2min缓解，此后一周内出现2次类似症状，服用丙戊酸钠后2年无发作；目前发作类型：精神先兆（似曾相识感）→言语自动→自动运动（吞咽、双手摸索）→GTCS，发作后不能回忆发作过程治疗：丙戊酸钠、拉莫三嗪个人史：母孕期正常，足月顺产，无生后缺氧窒息史；生长发育正常家族史：否认类似家族史ScalpEEGBGa-YuanMScalpEEGSZ-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcontinued-YuanMScalpEEGSZcon
7、tinued-YuanMScalpEEGSZcontinued-YuanM头皮脑电图间歇期：未见典型癫痫样放电发作期：1.临床：全身动作减少→自动运动→植物神经症状→复杂运动2.EEG：发作型，弥漫性，左侧前头部辅助检查头皮脑电图头颅MRI头PET神经心理评估辅助检查头皮脑电图头颅MRI头PET神经心理评估AFBJCDELM左侧半球左侧半球：A颞中回-杏仁核（16）B颞中回-海马头（16）C颞中回中部-海马旁回（16）D颞中回后部-海马后部（16）E颞上回-第2岛长回（12）F颞极（12）J额中回-第2-3岛短回、第1岛长回（
