ObjectiveTo explore the strategy and outcome of surgery for the treatment of encephalomalacia with secondary intractable epilepsy. MethodsDuring the period of July 2009 and June 2015, 21 cases of encephalomalacia with secondary intractable epilepsy were performed operation. Among them there were 16 males and 5 females. Their ages ranged from 4 to 34 years, with their illness duration from 3 to 14 years. According to the results of MRI and video-EEG monitoring, all the patients were performed operation under the monitoring of ECoG. And the outcome was graded by Engle scales for analysis. ResultsECoG monitoring after the resection of encephalomalacia showed that there was still abnormal discharge. Enlarged cortical resection was performed in 10 cases, and cortical coagulation in 3、anterior temporal lobectomy + resection of the hippocampus and amygdala in 4、additional callosotomy in 4. The post-operative follow-up of 1~7 years showed that Grade Ⅰ was observed in 10 cases、Grade Ⅱ in 5 cases、Grade Ⅲ in 3 cases and Grade Ⅳ in 3 cases.The total surgical effectiveness was 85.7%. ConclusionTo the patients of encephalomalacia with secondary intractable epilepsy, the epileptic lesion should be resected besides the resection of encephalomalacia. And the surgical effectiveness is satisfactory.
ObjectiveTo explore changes on Electroencephalograph (EEG) and Evoked Potential (EP) changes in autoimmune encephalitis.MethodsEight cases with autoimmune encephalitis from Sichuan people's hospital during July 18th 2014 to July 18th 2016 were recruited. The inclusion criteria included:① The blood and cerebral spinal fluid (CSF) of patients were sent to Neurology Lab of Peking Union Medical College Hospital for autoimmunerelated antibody analysis and confirmed as autoimmune encephalitis.2 Patient had done at least 2 or more times of routine EEG or video EEG (VEEG). 1 or more times of auditory brainstem response (ABR), Visual evoked potential (VEP) and Somatosensory evoked potential (SEP) for both upper and lower limbs. 3 Patients had classical clinical manifestation of autoimmune encephalitis as abnormal psychomotor behaviors, seizures, memory loss, fever, headache, and even disturbance of consciousness or decreased ventilate function.ResulstOf 8 patients in this study, 5 were anti NMDA-R encephalitis, 2 were anti GABABR encephalitis, and 1 was positive for both antibodies. The EEG profile of 5 anti NMDA-R encephalitis:2 of them had β wave in early stage (about 10th day) and δ wave with fast wave even appeared as δ brush in middle stage (about 20th day). They all had severe symptoms and long hospitalization but negative MRI. Another 2 of them could be seen sparsely distributed sharp wave and sharp-slow wave in their EEG. Their EEG gradually turned to normal when their symptoms gradually disappeared. The last one had normal EEG during the whole disease course. The EEG profile of anti GABAB-R encephalitis as following. 1 was dominant by slow wave and EEG went normal after effective treatment and the other showed generalized α wave especially α wave in frontal region. The latter patient withdraw treatment. For the only 1 both antibodies positive patient, EEG showed slow wave and it turned to normal when symptoms disappeared. EP showed some abnormalities with wave amplitude and latency changes in some patients.EP (SEP、VEP) turned to normal when symptoms disappeared.ConclusionThe EEG present differently in different types of autoimmune encephalitis and change with stages of disease. EEG may be used as an indicator for prognosis as well. When EEG shows fast wave with the history of patient points to encephalitis, blood and CSF antibodies for NMDA-R should be checked routinely. Generalized α wave on EEG should also be an indicator for checking GABAB-R. More researches should be done for EP changes in autoimmune encephalitis for our study was based on a small patient number.