[杏仁核增大的颞叶癫痫的临床病理特征]
[Clinico-pathological features of temporal lobe epilepsy with enlarged amygdala].
作者信息
Zhu S, Xu Z S, Xia Q, Fang X J, Zhao D H, Liu X Z
机构信息
Department of Neurology, Peking University International Hospital, Beijing 102206, China.
Department of Neurology, Peking University People's Hospital, Beijing 100044, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Oct 18;51(5):824-828. doi: 10.19723/j.issn.1671-167X.2019.05.006.
OBJECTIVE
To summarize the clinical, video electroencephalogram (VEEG), radiological and pathological features of 3 patients of temporal lobe epilepsy (TLE) with amygdala enlargement (AE).
METHODS
Three TLE patients with AE who were hospitalized in Peking University International Hospital were collected. The above features were retrospectively analyzed, and the amygdala volume was measured as well.
RESULTS
Of all the 3 patients, 2 were females and 1 male, whose seizure onset ages varied from 21 to 40 years. Two cases presented with secondarily generalized tonicclonic seizures after falling asleep during the night. One of the 2 cases had complex partial seizures (CPSs) with episodic memory and automatism after one year, and the third one had CPSs with lip smacking and tongue wagging during the night. All the patients suffered from obvious anxious disorder. Unilateral AE by MRI was demonstrated in the 3 cases, one on the right side, and the other two on the left side. The average amygdala volume of the enlarged side and the other side were (2 123.7±131.8) mm and (1 276.3±156.9) mm, respectively. Unilateral interictal epileptic discharges were ipsilateral to the AE in 2 cases, while the other patient showed bilateral interictal epileptic discharges. The ictal VEEG showed that the seizure onset zone was ipsilateral to the AE and was confined to the anterior and middle temporal regions in the 3 patients. The interictal single-photon emission computed tomography (SPECT) was negative in 2 cases. The interictal positron emission tomography (PET) showed hypometabolism in the AE in one case. The histological pathology revealed focal cortical dysplasia in the amygdala and temporal lobe in the 3 cases, and one of the 3 cases was combined with hippocampal sclerosis. All the patients became seizure free after surgery in the half year following-up. VEEG revealed slow wave activity and occasional spike wave in the operated side.
CONCLUSION
AE may be one subtype of TLE. It is necessary to recognize AE in TLE with MRI-negative. For those poorly responsive to antiepileptic drugs, surgical treatment could provide a better solution. Focal cortical dysplasia may be one of the most common pathological features of TLE with AE.
目的
总结3例伴有杏仁核增大（AE）的颞叶癫痫（TLE）患者的临床、视频脑电图（VEEG）、影像学及病理学特征。
方法
收集北京大学国际医院收治的3例伴有AE的TLE患者。对上述特征进行回顾性分析，并测量杏仁核体积。
结果
3例患者中，女性2例，男性1例，发病年龄为21～40岁。2例患者夜间入睡后出现继发性全身强直阵挛发作。其中1例在1年后出现伴有发作性记忆和自动症的复杂部分性发作（CPS），第3例在夜间出现伴有咂嘴和舔舌的CPS。所有患者均患有明显的焦虑症。3例患者MRI均显示单侧AE，1例在右侧，另2例在左侧。增大侧与对侧杏仁核平均体积分别为（2 123.7±131.8）mm³和（1 276.3±156.9）mm³。2例患者发作间期癫痫样放电与AE同侧，另1例患者发作间期癫痫样放电为双侧性。发作期VEEG显示发作起始区与AE同侧，3例患者均局限于颞叶中前部。2例患者发作间期单光子发射计算机断层扫描（SPECT）为阴性。1例患者发作间期正电子发射断层扫描（PET）显示AE区代谢减低。组织病理学检查显示3例患者杏仁核及颞叶均有局灶性皮质发育不良，其中1例合并海马硬化。所有患者术后半年随访无癫痫发作。VEEG显示术侧有慢波活动及偶发棘波。
结论
AE可能是TLE的一种亚型。对于MRI阴性的TLE患者，有必要认识到AE。对于抗癫痫药物反应不佳者，手术治疗可能是更好的解决办法。局灶性皮质发育不良可能是伴有AE的TLE最常见的病理特征之一。
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