Nelles M, Bien C G, Kurthen M, von Falkenhausen M, Urbach H
Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud Str. 25, 53105 Bonn, Germany.
Neuroradiology. 2006 Jul;48(7):443-8. doi: 10.1007/s00234-006-0080-5. Epub 2006 May 4.
Transient splenium corporis callosi (SCC) lesions are related to rapid reduction of antiepileptic drugs (AEDs). The range of substances with predilection for SCC changes, their pathophysiology and their occurrence are still unknown.
In a prospective 2-year study an epilepsy-dedicated MRI protocol supplemented by DWI and ADC maps was performed after AED withdrawal for diagnostic seizure provocation in all patients with pharmacoresistant seizures locally admitted to the Department of Epileptology.
Of 891 presurgical epilepsy patients, 6 (0.7%) had SCC lesions with cytotoxic edema on DWI. Carbamazepine combined with other AEDs was administered in five of those patients. In the study period we observed identical lesions in a schizophrenic patient treated with olanzapine and citalopram, in a patient with oropharyngeal carcinoma treated with alkylating agents, and in a hypernatremic patient following neurohypophyseal granular cell tumor surgery.
Transient SCC lesions are related to rapid AED reduction but may occur in similar conditions with fluid balance alterations. We contribute further clinical data in this field to better classify the pharmaceuticals that are prone to the described cerebral cytotoxic side effects in the SCC and to clarify their incidence among presurgical epilepsy patients.
胼胝体压部（SCC）短暂性病变与抗癫痫药物（AEDs）的快速减量有关。易累及SCC的物质范围、其病理生理学及发生情况仍不清楚。
在一项为期2年的前瞻性研究中，对所有当地癫痫科收治的药物难治性癫痫患者，在停用AEDs后进行专门的癫痫MRI检查方案，并辅以弥散加权成像（DWI）和表观扩散系数（ADC）图以诱发诊断性癫痫发作。
在891例术前癫痫患者中，6例（0.7%）在DWI上有伴有细胞毒性水肿的SCC病变。其中5例患者曾联用卡马西平和其他AEDs。在研究期间，我们在1例接受奥氮平和西酞普兰治疗的精神分裂症患者、1例接受烷化剂治疗的口咽癌患者以及1例垂体神经部颗粒细胞瘤手术后出现高钠血症的患者中观察到了相同的病变。
SCC短暂性病变与AEDs快速减量有关，但在伴有液体平衡改变的类似情况下也可能发生。我们提供了该领域更多的临床数据，以便更好地对易导致SCC出现上述脑细胞毒性副作用的药物进行分类，并明确其在术前癫痫患者中的发生率。
