Abstract: Objective To explore the clinical features,electroencephalogram characteristics and postoperative efficacy of orbitofrontal epilepsy and its plus confirmed by stereotactic electroencephalography. Methods A retrospective analysis was conducted on 12 patients diagnosed with orbitofrontal epilepsy and its plus.The clinical features and electroencephalogram characteristics of these patients were summarized.All patients underwent surgical treatment and were followed up for more than one year.The postoperative efficacy was evaluated using the Engel classification system. Results Among the 12 patients,the core symptoms manifested as excessive movement,complex movements,and 8 of them initially presented as silent periods during the attack stage.Among the intracranial electroencephalograms,8 cases originated purely from the orbitofrontal gyrus,1 case originated from the orbital-temporal-insular region,1 case originated from the orbital-frontal-temporal region,1 case originated from the orbital-frontal region,and 1 case originated from the orbital-temporal region.In the brain waves originating from the pure orbitofrontal gyrus,5 cases showed conduction from the lateral orbital gyrus to the other parts of the frontal area,and 2 cases showed conduction from the medial orbital gyrus to the temporal area.11 cases underwent craniotomy for epilepsy focus resection,and 1 case underwent stereotactic electroencephalogram-guided radiofrequency thermocoagulation.The average postoperative follow-up was 47.67 months.Among them,7 cases had Engel I,4 cases had Engel II,and 1 case had Engel III.There were no permanent functional deficits after the operation. Conclusion Stereotactic electroencephalography is helpful for the diagnosis of orbitofrontal epilepsy and its puls; the electroencephalogram of medial orbitofrontal epilepsy tends to conduct to the temporal region,while that of lateral orbitofrontal epilepsy tends to conduct to the other parts of the frontal area; the surgical effectiveness rate of pure orbitofrontal epilepsy is higher than that of orbitofrontal epilepsy with its puls.

Key words: Stereotactic electroencephalography, Orbitofrontal epilepsy, Clinical features, Postoperative efficacy

摘要： 目的 探讨经立体定向脑电图证实的眶额回癫痫及其附加症的临床表现、脑电图特点及其术后疗效。方法 回顾性分析确诊为眶额回癫痫及其附加症的12例患者,总结其临床表现及脑电图特点。所有患者均行手术治疗,随访时间1年以上,术后疗效采用Engel分级。结果 12例患者中,核心症状学表现为过度运动、复杂运动等运动症状,其中有8例在发作期首先表现为静默期。颅内脑电中8例纯眶额回起始,1例眶+颞岛、1例眶+额颞、1例眶+额、1例眶+颞同时起源;在纯眶额回起始的脑电传导中,5例外侧眶回起始向其他额区传导,2例内侧眶回起始向颞区传导。11例行开颅致痫灶切除手术,1例行立体定向脑电图引导下射频热凝毁损术。术后平均随访47.67个月,其中Engel I级7例,Engel II级4例,Engel III级 1例,术后均无永久性功能缺损。结论 立体定向脑电图有助于眶额回癫痫及其附加症的诊断;内侧眶额回癫痫的脑电倾向于向颞区传导,外侧眶额回癫痫的脑电倾向于向其他额区传导;纯眶额回癫痫手术有效率高于眶额回附加。

关键词: 立体定向脑电图, 眶额回癫痫, 临床表现, 术后疗效