MRI阴性而PET阳性的颞叶癫痫:一组可应用手术治疗的症候群

作     者：Carne R.P. O'Brien T.J. Kilpatrick C.J. 杜芳 

作者机构：Department of Clinical Neurosciences Geelong Hospital Kardin ia House Bellerine St Geelong Vic. 3220 Australia Dr. 

出 版 物：《世界核心医学期刊文摘（神经病学分册）》 (Digest of the World Core Medical Journals:Clinical Neurology)

年 卷 期：2005年第1卷第3期

页      面：32-32页

学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学] 

主　　题：颞叶癫痫 MRI PET 海马硬化 异常放电 δ节律 病理生理机制 热惊厥 皮质区 临床病理学 

摘      要：Most patients with non lesional temporal lobe epilepsy (NL TLE) will have th e findings of hippocampal sclerosis (HS) on a high resolution MRI. However, a si gnificant minority of patients with NLTLE and electroclinically well lateral i zed temporal lobe seizures have no evidence of HS on MRI. Many of these patients have concordant hypometabolism on fluorodeoxyglucose PET([ 18F]FDG PET). Th e pathophysiological basis of this latter group remains uncertain. We aimed to det ermine whether NLTLE without HS on MRI represents a variant of or a different cl inicopathological syndrome from that of NLTLE with HS on MRI. The clinical, EEG, [18F]FDG PET, histopathological and surgical outcomes of 30 consecutive NLTL E patients with well lateralized EEG but without HS on MRI (HS ve TLE) were comp ared with 30 consecutive age and sexmatched NLTLE patients with well lateraliz ed EEG with HS on MRI (HS+ve TLE). Both the HS+ve TLE group and the HS ve TLE patients had a high degree of [18F] FDG PET concordant lateralization (26 o ut of 30 HS ve TLE versus 27 out of 27 HS+ve TLE). HS ve TLE patients had more widespread hypometabolism on [18F]FDG PET by blinded visual analysis [odds r ati o (OR = +∞(2.51-+∞), P = 0.001]. The HS ve TLE group less frequently had a history of febrile convulsions [OR = 0.077 (0.002-0.512), P = 0.002], more c om monly had a delta rhythm at ictal onset [OR = 3.67 (0.97-20.47), P = 0.057], an d less frequently had histopathological evidence of HS [OR = 0 (0-0.85), P -0 . 031]. There was no significant difference in surgical outcome despite half of t h ose without HS having a hippocampal sparing procedure. Based on the findings ou tlined, HS ve PET positive TLE may be a surgically remediable syndrome distinc t from HS+ve TLE, with a pathophysiological basis that primarily involves later al temporal neocortical rather than mesial temporal structures.