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磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范

激光间质热疗术（Laser interstitial thermal therapy，LITT）由Bown于1983年首次描述， 1990年Sugiyama首次使用该术式治疗脑部病变，美国食品药品监督管理局（Food and Drug Administration，FDA）于2007年批准了LITT治疗颅内疾病，Curry等于2012年报道了磁共振引导下激光间质热疗术（MRI-guided laser interstitial thermal therapy，MgLITT）治疗癫痫。此后，MgLITT治疗癫痫得到了迅速的发展。来自论文的数据统计显示，世界范围内共有1800多例癫痫患者接受了MgLITT手术，涉及的病理包括下丘脑错构瘤（Hypothalamic hamartoma，HH）、颞叶内侧硬化、局灶性皮质发育不良（Focal cortical dysplasia，FCD）、各种发育性肿瘤、海绵状血管畸形等。依据诸多文献报道的结果，MgLITT治疗多种病理所致癫痫的疗效不劣于传统的开颅切除性手术，并以安全、准确、微创的优势，在未来可能改变癫痫外科的手术模式。目前已上市的MgLITT设备包括美国Medtronic公司的Visualase系统和加拿大Monteris公司的NeuroBlate系统，我国的Sinovation公司于2020年研制出国产MgLITT系统，同年完成动物实验并开始了上市前的临床试验。2020年8月12日北京天坛医院率先开展了MgLITT治疗一例颞叶内侧癫痫，截止到2022年5月，已完成230例MgLITT治疗不同病理类型癫痫的手术，初步积累了相关的经验。清华大学玉泉医院于2020年11月开始开展MgLITT治疗难治性癫痫患者，证实在非术中磁共振条件下也可安全有效的开展MgLITT治疗。中国抗癫痫协会谭启富基金管理委员会委托北京天坛医院和清华大学玉泉医院相关人员撰写MgLITT手术操作规范，从术前患者筛选、手术流程和术后管理等方面分别介绍，旨在助力于这一技术未来在中国的规范开展。

癫痫术后单纯疱疹病毒脑炎复发病例之诊治过程及脑电图变化并文献复习

SEEG-guided radiofrequency thermocoagulation ablation for tuberous sclerosis-associated epilepsy

ObjectiveTo study the therapeutic efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermo-coagulation ablation (RF-TC) in the treatment of tuberous sclerosis (TSC) related epilepsy and to investigate the prediction of the therapeutic response to SEEG-guided RF-TC for the efficacy of the subsequent surgical treatment. MethodsWe retrospectively analyze TSC patients who underwent SEEG phase II evaluation from January 2014 to January 2023, and to select patients who underwent RF-TC after completion of SEEG monitoring, study the seizure control of patients after RF-TC, and classify patients into effective and ineffective groups for RF-TC treatment according to the results of RF-TC treatment, compare the surgical outcomes of patients in the two groups after SEEG, to explore the prediction of surgical outcome by RF-TC treatment. Results59 patients with TSC were enrolled, 53 patients (89.83%) were genetic detection, of which 28 (52.83%) were TSC1-positive, 21 (39.62%) were TSC2-positive, and 4 (7.54%) were negative, with 33 (67.34%) de novo mutations. The side of the SEEG electrode placement: left hemisphere in 9 cases, right hemisphere in 13 cases, and bilateral hemisphere in 37 cases. 37 patients (62.71%) were seizure-free at 3 months, 31 patients (52.54%) were seizure-free at 6 months, 29 patients (49.15%) were seizure-free at 12 months, and 20 patients (39.21%) were seizure-free at 24 months or more. 11 patients had a seizure reduction of more than 75% after RF-TC, and the remaining 11 patients showed no significant change after RF-TC. There were 48 patients (81.35%) in the effective group and 11 patients (18.65%) in the ineffective group. In the effective group, 22 patients were performed focal tuber resection laser ablation, 19 cases were seizure-free (86.36%). In the ineffective group, 10 patients were performed focal tuber resection laser ablation, only 5 cases were seizure-free (50%), which was a significant difference between the two groups (P<0.05). ConclusionsOur data suggest that SEEG guided RF-TC is a safe and effective both diagnostic and therapeutic treatment for TSC-related epilepsy, and can assist in guiding the development of future resective surgical strategies and determining prognosis.

眶额外侧和眶额内侧癫痫的电临床特点—病例系列