腹型癫痫的外科干预:诊断与疗效分析

doi:10.19854/j.cnki.1008-2425.2025.05.0004

摘要/Abstract

摘要： 目的本研究基于腹型癫痫的临床特征,通过整合视频脑电图(VEEG)、磁共振(MRI)、正电子发射断层扫描(PET-CT)、立体定向颅内电极(SEEG)等诊断技术,综合建立个体化腹型癫痫诊疗方案,系统分析其临床特征及手术治疗效果。方法回顾性分析2016年4月～2024年7月就诊的11例腹型癫痫患者,分析患者的临床特征、VEEG、MRI、PET-CT、SEEG等资料,评估诊断准确性及手术效果。结果 11例患者年龄范围3~25岁,平均年龄11.5±7.8岁,其中儿童(≤12岁)8例,成人3例,发作形式均以发作性腹痛起病,伴自主神经症状(5例)或运动症状(5例)或自动症(3例)。MRI显示颞叶结构异常患者7例,其中5例结构异常位置与PET-CT代谢异常位置重叠,头皮脑电图(6例)与SEEG(3例)显示颞叶发作起源。11例患者中,1例未接受手术治疗,10例采用病灶切除治疗患者,其中9例EngelⅠ级,1例EngelⅢ级,总有效率90%。结论腹型癫痫的致痫网络主要涉及颞叶-边缘系统,多种技术结合可显著提高诊断准确性,手术治疗对难治性癫痫患者具有显著疗效,但需重点关注术后神经系统及认知功能损伤的评估与干预。

关键词: 腹型癫痫, 诊断, 颞叶-边缘网络, 立体定向颅内脑电图, 手术疗效

Abstract: Objective This study aimed to develop individualized diagnostic and therapeutic strategies for abdominal epilepsy by integrating its clinical characteristics with multimodal techniques including video electroencephalography (VEEG),magnetic resonance imaging (MRI),positron emission tomography-computed tomography (PET-CT),and stereotactic electroencephalography (SEEG),and to systematically evaluate the clinical features and surgical outcomes. Methods We conducted a retrospective review of 11 patients diagnosed with abdominal epilepsy between April 2016 and July 2024.Clinical profiles and findings from VEEG,MRI,PET-CT,and SEEG were analyzed to assess diagnostic precision and surgical efficacy. Results The cohort consisted of 11 patients aged 3 to 25 years (mean age 11.5±7.8 years),including 8 children (≤12 years) and 3 adults.All patients (100%) presented with paroxysmal abdominal pain as the initial manifestation,accompanied by autonomic symptoms (5 cases),motor symptoms (5 cases),or automatisms (3 cases).MRI revealed temporal lobe structural abnormalities in 7 patients,with colocalization of structural and PET-CT metabolic abnormalities observed in 5 cases.Both scalp EEG (6 cases) and SEEG (3 cases) indicated a temporal lobe seizure origin.Among the 11 patients,10 underwent lesion resection,resulting in Engel class I outcome in 9 cases and Engel class III in 1 case,yielding an overall effectiveness rate of 90%.One patient did not receive surgical intervention. Conclusion The epileptogenic network in abdominal epilepsy primarily involves the temporal-limbic system.Multimodal evaluation significantly enhances diagnostic accuracy,and surgical intervention demonstrates substantial efficacy for drug-resistant cases.Postoperative assessment and management of neurological and cognitive functions warrant focused attention.

Key words: Abdominal Epilepsy, Diagnosis, Temporal-limbic Network, Stereotactic electroencephalography (SEEG), Surgical outcome

中图分类号:

R742.1

郎永翠, 胡月, 刘垚岭, 张宁宁, 李文倩, 张光明. 腹型癫痫的外科干预:诊断与疗效分析[J]. 立体定向和功能性神经外科杂志, 2025, 38(5): 278-283.

Lang Yongcui, Hu Yu, Liu Yaoling, Zhang Ningning, Li Wenqian, Zhang Guangming. The Role of Surgery in Abdominal Epilepsy:A Comprehensive Evaluation of Diagnostic and Therapeutic Outcomes[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(5): 278-283.

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