Schulze-Bonhage A, Elger C E
Clinic of Epileptology, University of Bonn, Germany.
Epilepsia. 2000 Feb;41(2):186-92. doi: 10.1111/j.1528-1157.2000.tb00138.x.
This study addressed the efficacy of flumazenil (FMZ) to induce or activate interictal or ictal epileptic discharges in patients with medically intractable partial epilepsies.
Flumazenil, 1 mg, was injected intravenously in 67 patients undergoing presurgical monitoring for epilepsy surgery, 49 of whom had been treated with benzodiazepines (BZDs) before flumazenil was given. Continuous video electroencephalogram (EEG) monitoring with surface or intracranial electrodes was used to evaluate interictal EEG activity, ictal discharges, and the occurrence and semiology of clinically manifest epileptic seizures.
Interictal epileptiform potentials did not change in frequency or distribution after FMZ. In patients not pretreated with BZDs, epileptic seizures could not be provoked. In eight of the 49 patients pretreated with BZDs, epileptic seizures occurred within 30 min of FMZ application. Seizure semiology and regional EEG onset were identical to seizures recorded without FMZ. Patients operated on according to seizure-onset localization with FMZ had a >75% reduction in seizure frequency or became seizure free.
Seizure induction by FMZ seems to be a valid method for evaluating seizure semiology and localization of the seizure-onset zone during presurgical monitoring of patients with medically intractable localization-related epilepsies.
本研究探讨氟马西尼（FMZ）诱发或激活药物难治性部分性癫痫患者发作间期或发作期癫痫放电的疗效。
对67例接受癫痫手术术前监测的患者静脉注射1mg氟马西尼，其中49例在给予氟马西尼之前接受过苯二氮䓬类药物（BZDs）治疗。使用表面电极或颅内电极进行连续视频脑电图（EEG）监测，以评估发作间期EEG活动、发作期放电以及临床表现性癫痫发作的发生情况和症状学。
FMZ后发作间期癫痫样电位的频率和分布未发生变化。在未接受BZDs预处理的患者中，无法诱发癫痫发作。在49例接受BZDs预处理的患者中，有8例在应用FMZ后30分钟内出现癫痫发作。发作症状学和局部EEG起始与未使用FMZ时记录的发作相同。根据FMZ发作起始定位进行手术的患者癫痫发作频率降低>75%或无癫痫发作。
在药物难治性局灶性癫痫患者的术前监测中，FMZ诱发癫痫发作似乎是评估发作症状学和发作起始区定位的有效方法。
