Akanuma N, Arima K, Adachi N, Anami K, Onuma T
Department of Psychiatry, National Center Hospital for Mental, Nervous and Muscular Disorders, Tokyo, Japan.
No To Shinkei. 1995 Jun;47(6):575-9.
The authors report an 85-year-old man with schizophrenia, who had undergone bilateral frontal gyrectomy at the age of 44 and had a single series of convulsions 6 months after the psychosurgery. Forty-one years later, he had developed partial seizures with secondary generalized seizures, and died of partial status epilepticus. Ictal EEG showed generalized high-amplitude spikes or sharp waves spreading from the left frontal region. Interictal EEG showed slowing of background activity and high-amplitude paroxysmal discharges on the left frontal and central regions. Postmortem examination of the brain revealed tissue defects in the superior and middle frontal gyri caused by resection at the time of gyrectory and old cysts in the deep frontal white matter as late sequelae of the psychosurgery. There was fibrillary gliosis in the surrounding cerebral convolutions and the deep white matter. We considered that the glial scar in the frontal lobes, on the left side in particular, had developed the epileptogenic focus. The pathophysiological mechanism by which the intractable epileptic seizures appeared 41 years after psychosurgery is discussed.
作者报告了一名85岁的精神分裂症男性患者，他在44岁时接受了双侧额叶脑回切除术，术后6个月出现了单次惊厥发作。41年后，他发展为部分性发作继发全身性发作，并死于部分性癫痫持续状态。发作期脑电图显示高幅棘波或尖波从左侧额叶区域扩散。发作间期脑电图显示背景活动减慢，左侧额叶和中央区域有高幅阵发性放电。死后脑部检查发现额叶上回和中回因脑回切除时的手术造成组织缺损，以及深部额叶白质中有陈旧性囊肿，这是精神外科手术的晚期后遗症。周围脑回和深部白质有纤维性胶质增生。我们认为额叶尤其是左侧的胶质瘢痕形成了致痫灶。本文讨论了精神外科手术后41年出现难治性癫痫发作的病理生理机制。
