Spencer D C, Morrell M J, Risinger M W
Department of Neurology, Oregon Health Sciences University, Portland, USA.
Epilepsia. 2000 Mar;41(3):320-5. doi: 10.1111/j.1528-1157.2000.tb00162.x.
To examine the role of the intracarotid amobarbital procedure (IAP) in the presurgical evaluation of patients with medically refractory localization-related epilepsy.
We retrospectively studied 111 patients who underwent cortical resective surgery at our center between 1991 and 1996. In patients with mesial temporal lobe epilepsy (mTLE), a presurgical determination of the epileptogenic zone was compared with localization based on IAP memory asymmetry scores, and with ultimate localization after resective surgery. In patients with neocortical or mesial frontal epilepsy, the IAP was evaluated for evidence of unilateral or bilateral poor memory performance.
Of 68 patients with mTLE localized by noninvasive tests, 60 had concordant lateralized memory deficits on IAP. Eight patients had lateralized memory deficits on IAP that were discordant with noninvasive tests and with localization as determined by surgical outcome. All 11 mTLE patients requiring invasive EEG monitoring were correctly lateralized by IAP, including one patient in whom the noninvasive evaluation otherwise provided false lateralization. Of 32 patients with neocortical or mesial frontal lobe epilepsy, 21 displayed memory deficits on IAP. Of 10 patients with bilateral deficits, five had mesial frontal lobe epilepsy. In 13 patients with lateralized memory deficits, seven underwent electrode implantation in the mesial temporal lobe, and four ultimately underwent resection of an epileptogenic mesial temporal lobe in addition to a neocortical resection.
In patients with mTLE, lateralized memory deficits on IAP usually confirm localization provided by noninvasive tests. However, in mTLE not well lateralized by the noninvasive evaluation, and in neocortical or mesial frontal epilepsy, the IAP may provide information regarding localization that ultimately alters surgical management.
探讨颈内动脉阿米妥试验（IAP）在药物难治性局灶性癫痫患者术前评估中的作用。
我们回顾性研究了1991年至1996年间在本中心接受皮质切除术的111例患者。对于内侧颞叶癫痫（mTLE）患者，将术前确定的致痫区与基于IAP记忆不对称评分的定位以及切除术后的最终定位进行比较。对于新皮质或内侧额叶癫痫患者，评估IAP以寻找单侧或双侧记忆功能不佳的证据。
在68例通过无创检查定位的mTLE患者中，60例在IAP上有一致的记忆侧化缺陷。8例患者在IAP上有记忆侧化缺陷，与无创检查及手术结果确定的定位不一致。所有11例需要进行有创脑电图监测的mTLE患者通过IAP均正确侧化，包括1例无创评估提供了错误侧化的患者。在32例新皮质或内侧额叶癫痫患者中，21例在IAP上显示出记忆缺陷。在10例双侧缺陷患者中，5例患有内侧额叶癫痫。在13例有记忆侧化缺陷的患者中，7例在内侧颞叶植入电极，4例最终除新皮质切除外还切除了致痫的内侧颞叶。
在mTLE患者中，IAP上的记忆侧化缺陷通常证实无创检查提供的定位。然而，在无创评估未很好侧化的mTLE以及新皮质或内侧额叶癫痫中，IAP可能提供有关定位的信息，最终改变手术治疗方案。
