X刀低剂量治疗癫痫临床分析.docVIP

X刀低剂量治疗癫痫临床分析[摘要] 目的：对X刀治疗癫痫进行临床观察。方法：选择明确诊断的难治性癫痫，经过EEG或AEEG、MRI、MRS、FLAIR、SPECT等检查，结合临床症状，对定位明确的致痫灶行X刀治疗。结果：X刀治疗137例，随访6～29个月，满意73例，显著改善和良好37例，较差和无效27例，癫痫控制率为53.2%，有效率为80.3%。结论：X刀治疗难治性癫痫是一种安全有效的治疗手段，关键是准确定位致痫灶，但对原发性癫痫疗效较差，有待进一步研究。 [关键词] X刀；难治性癫痫；核磁共振波谱 [中图分类号] R742.1 [文献标识码]B[文章编号]1673-7210（2010）10（b）-155-02 Clinical analysis of the X knife treating epilepsy with low dose LIU Jianmin1, WANG Hui1, YU Weiqi2 (1.Department of Radiotherapy, the Third People′s Hospital of Luoyang City, Luoyang 471002, China; 2.Department of Radiotherapy, the 150th Hospital of PLA, Luoyang 471000, China) [Abstract] Objective: To observe the clinical result of X knife treating epilepsy. Methods: Doing X knife to the refractory epilepsy, through inspections of EEG or MRS, AEEG, MRI, FLAIR, SPECT, and so on, combined with clinical symptoms. Results: 137 cases were treated by X knife. Follow-up visits for 6-29 months. Among them, 73 cases were satisfactory; in 37 cases there were remarkable improved; for the rest(37 cases), X knife treatment was invalid. The inverse amplification factor of epilepsy was 53.2%, and the effectiveness was 80.3%. Conclusion: X knife treatment to epilepsy is a safe and effective treatment way, the key is the accurate localization of epilepsy focus. But the effectiveness of primary epilepsy is not perfect, and this needs further studies. [Key words] X knife; Refractory epilepsy; Magnetic resonance spectrum (MRS) 近年来，立体定向放射外科（X刀）治疗难治性癫痫取得了一定的经验，并由于无痛苦、无明显不良反应、无严重并发症，已被患者所接受。笔者2004年8月～2007年1月利用X刀低剂量治疗难治性癫痫患者137例，现报道如下： 1 资料与方法 1.1 一般资料 本组137例患者中，男82例，女55例；年龄6～80岁，平均24岁；其中部分性发作（单纯及复杂性以及继发性全身强直-阵挛性）81例，全身强直-阵挛性发作7例，失神发作24例，失张力及非典型发作13例，肌阵挛性发作2例，强直性发作12例；病程最短2年，最长58年，平均12.1年。137例患者病史中，有幼儿高热惊厥病史21例，有难产（包括胎位不正、脐绕颈、产后窒息、早产等）史16例，有外伤史47例，CO中毒史7例，颅内肿瘤、动静脉畸形等9例，有病毒性脑炎病史4例，有家族史6例，原因不明31例。 1.2 治疗前检查 所有患者均检查脑电图（EEG）或动态脑电图（AEEG）、MRI、核磁共振波谱（MRS），必要时加作液体衰减反转恢复（FLAIR）成像。部分患者检查SPECT，仅个别病例检查了PET。经综合判断，海马和（或）颞叶N-乙酰天门冬氨酸（NAA）/[胆碱（Cho）+肌酸（Cr）]比值异常、