Ho S S, Berkovic S F, McKay W J, Kalnins R M, Bladin P F
Department of Neurology, Austin, and Repatriation Medical Centre, Heidelberg (Melbourne), Australia.
Epilepsia. 1996 Aug;37(8):788-95. doi: 10.1111/j.1528-1157.1996.tb00653.x.
We studied cerebral perfusion patterns in the various subtypes of TLE, as determined by pathology and good outcome after temporal lobectomy (as confirmation of temporal origin).
We studied clinical features and ictal technetium 99m hexamethyl-propyleneamineoxime (99mTc-HM-PAO) single-photon emission-computed tomography (SPECT) in four subgroups of patients with intractable temporal lobe epilepsy (TLE) treated with surgery: hippocampal sclerosis (group 1, n = 10), foreign-tissue lesion in mesial temporal lobe (group 2, n = 8), foreign-tissue lesion in lateral temporal lobe (group 3, n = 7), and normal temporal lobe tissue with good surgical outcome (group 4, n = 5).
No major clinical differences in auras, complex partial seizures or postictal states were identified among the groups. Ictal SPECT showed distinct patterns of cerebral perfusion in these subtypes of TLE. In groups 1 and 2, hyperperfusion was seen in the ipsilateral mesial and lateral temporal regions. In group 3, hyperperfusion was seen bilaterally in the temporal lobes with predominant changes in the region of the lesion. Hyperperfusion was restricted to the ipsilateral anteromesial temporal region in group 4. Ipsilateral temporal hyperperfusion in mesial onset seizures can be explained by known anatomic projections between mesial structures and ipsilateral temporal neocortex. Bilateral temporal hyperperfusion in lateral onset seizures can be explained by the presence of anterior commissural connections between lateral temporal neocortex and the contralateral amygdala.
We conclude that the perfusion patterns seen on ictal SPECT are helpful for subclassification of temporal lobe seizures, whereas clinical features are relatively unhelpful. These perfusion patterns provide an insight into preferential pathways of seizure propagation in the subtypes of TLE.
我们研究了颞叶癫痫（TLE）不同亚型的脑灌注模式，这些亚型由病理学以及颞叶切除术后的良好预后（作为颞叶起源的确认）所确定。
我们研究了接受手术治疗的难治性颞叶癫痫（TLE）患者四个亚组的临床特征和发作期锝99m六甲基丙烯胺肟（99mTc-HM-PAO）单光子发射计算机断层扫描（SPECT）：海马硬化（第1组，n = 10）、内侧颞叶的异物性病变（第2组，n = 8）、外侧颞叶的异物性病变（第3组，n = 7）以及颞叶组织正常且手术效果良好（第4组，n = 5）。
各组在先兆、复杂部分性发作或发作后状态方面未发现重大临床差异。发作期SPECT显示这些TLE亚型存在不同的脑灌注模式。在第1组和第2组中，同侧内侧和外侧颞叶区域出现灌注增强。在第3组中，双侧颞叶出现灌注增强，病变区域变化更为明显。第4组的灌注增强局限于同侧前内侧颞叶区域。内侧起始发作时同侧颞叶灌注增强可通过内侧结构与同侧颞叶新皮质之间已知的解剖投射来解释。外侧起始发作时双侧颞叶灌注增强可通过外侧颞叶新皮质与对侧杏仁核之间存在的前连合连接来解释。
我们得出结论，发作期SPECT上所见的灌注模式有助于颞叶癫痫发作的亚分类，而临床特征相对无帮助。这些灌注模式为TLE亚型中癫痫传播的优先途径提供了见解。
