Zhao Quanjun, Shi Tiejun, Cui Shaojie, Wu Zhaohui, Wang Wei, Jia Yunfeng, Tian Zengmin, Wang Fuli, Yin Feng, Zhao Hulin, Xiao Xia, Wang Haiying, Cai Changlan, Luo Huimin
Neurosurgery Department, The 306 Hospital of PLA, Beijing.
Neurosurgery Department, Navy General Hospital, Beijing.
Epileptic Disord. 2017 Jun 1;19(2):152-165. doi: 10.1684/epd.2017.0914.
Some patients with temporal lobe epilepsy have bilateral discharges and a few have bilateral medial temporal sclerosis. Stereotactic bilateral radiofrequency thermocoagulation (RFTC) of the amygdalohippocampal complex can terminate seizures or reduce seizure severity in patients with bilateral medial temporal lobe epilepsy (BMTLE). To explore the safety and efficacy of bilateral transfrontal minimal RFTC of the amygdalohippocampal complex for the treatment of BMTLE. A total of 12 BMTLE patients were treated with bilateral transfrontal minimal RFTC of the amygdalohippocampal complex under limited coagulations. The volumes of coagulated lesions were less than 0.6 cm Clinical outcomes were evaluated using Engel's classification, the Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale-Revised (WAIS-R), and Wechsler Memory Scale-Revised (WMS-R). Quality of life (QOL) was evaluated using the 36-item Short Form Health Survey (SF-36). Of the 12 patients, five (42%) were assessed as Engel Class I during 12-62 months of follow-up. LSSS scores declined sharply compared with the baseline of patients not in the seizure-free category. Functions of memory and intelligence declined transiently without statistical significance (p>0.05) immediately after surgery, but improved significantly (p<0.05) six months later. The qualities of life improved except vitality. Bilateral transfrontal minimal RFTC of the amygdalohippocampal complex may terminate seizures or reduce seizure severity in patients with BMTLE. Under limited coagulations, neuropsychological function was not affected but improved along with seizure control.
一些颞叶癫痫患者有双侧放电，少数患者有双侧内侧颞叶硬化。杏仁核 - 海马复合体的立体定向双侧射频热凝术（RFTC）可使双侧内侧颞叶癫痫（BMTLE）患者的癫痫发作终止或减轻发作严重程度。为探讨双侧经额部杏仁核 - 海马复合体最小化RFTC治疗BMTLE的安全性和有效性。对12例BMTLE患者在有限热凝条件下进行双侧经额部杏仁核 - 海马复合体最小化RFTC治疗。凝固灶体积小于0.6立方厘米。使用恩格尔分类、利物浦癫痫严重程度量表（LSSS）2.0、韦氏成人智力量表修订版（WAIS - R）和韦氏记忆量表修订版（WMS - R）评估临床疗效。使用36项简明健康调查（SF - 36）评估生活质量（QOL）。12例患者中，5例（42%）在12至62个月的随访期间被评估为恩格尔I级。与未达到无发作状态的患者基线相比LSSS评分大幅下降。术后即刻记忆和智力功能短暂下降但无统计学意义（p>0.05），但6个月后显著改善（p<0.05）。除活力外生活质量有所改善。双侧经额部杏仁核 - 海马复合体最小化RFTC可能使BMTLE患者的癫痫发作终止或减轻发作严重程度。在有限热凝条件下，神经心理功能未受影响，但随癫痫控制而改善。
