Matsuda K, Mihara T, Tottori T, Ohtsubo T, Baba K, Matsuyama N, Watanabe Y, Inoue Y, Yagi K
National Epilepsy Center, Shizuoka Higashi Hospital, Shizuoka 420-8688.
Rinsho Byori. 2001 Jan;49(1):29-38.
There exist various morphological and biochemical changes closely associated with electrophysiological phenomena which cause epileptic seizures in the brains of epilepsy patients. Recent developments in investigation methods, not only electrophysiological(EEG and MEG), but also neuroimaging involving morphological imaging(CT and conventional MRI) and functional imaging(SPECT, PET, functional MRI and MRS) is able to demonstrate these changes. SPECT and PET can particularly clarify the changes of cerebral blood flow and glucose metabolism between interictal and ictal periods. In our experience of 423 patients who underwent epilepsy surgery for intractable seizures, these interventions provide important information to identify the epileptogenic foci. However, in practice, discordance in the results of these presurgical evaluations is recognized, and invasive intracranial recordings are needed in such cases. These problems in diagnosis were shown especially in patients with mesial temporal sclerosis and focal cortical dysplasia. To detect an epileptogenic focus more clearly, a combination of morphological and functional findings, new functional imaging such as neurotransmitter receptor imaging, EEG-triggered or neuropharmacological functional MRI, as well as, statistical parametric analysis may be needed.
在癫痫患者大脑中，存在各种与导致癫痫发作的电生理现象密切相关的形态学和生化变化。研究方法的最新进展，不仅包括电生理学方法（脑电图和脑磁图），还包括神经影像学，其中形态学成像（计算机断层扫描和传统磁共振成像）和功能成像（单光子发射计算机断层扫描、正电子发射断层扫描、功能磁共振成像和磁共振波谱）都能够显示这些变化。单光子发射计算机断层扫描和正电子发射断层扫描尤其能够阐明发作间期和发作期之间脑血流和葡萄糖代谢的变化。根据我们对423例因顽固性癫痫发作接受癫痫手术患者的经验，这些检查手段为确定致痫灶提供了重要信息。然而，在实际操作中，术前评估结果存在不一致的情况，在这些病例中需要进行有创颅内记录。这些诊断问题在颞叶内侧硬化和局灶性皮质发育不良患者中尤为明显。为了更清晰地检测致痫灶，可能需要将形态学和功能学结果相结合，采用新的功能成像方法，如神经递质受体成像、脑电图触发或神经药理学功能磁共振成像，以及统计参数分析。
