ObjectiveTo explore the related risk factors of epilepsy after traumatic skull defect repair.MethodsThe clinical data of 72 cases patients underwent cranial three-dimensional titanium mesh repair in Neurosurgery Department of Sichuan Baoshihua Hospital from February 2010 to December 2017 were collected and followed up for 6 months, retrospectively analysed the causes and operation problems of secondary epilepsy after repair.Results21 casese (29.2%) among the 72 cases patients underwent cranioplasty were found with secondary epilepsy. Univariate analysis showed that the rate of secondary epilepsy in patients with softening lesion of gray matter, no formal antiepileptic treatment after the first operation, suspension of dural during operation and repair time of the trauma >6 months was significantly higher than that in patients without secondary epilepsy (P<0.05). Multivariate Logistic regression was used to correct the results, showing that softening lesion in the gray matter [OR=8.425, 95% CI (2.541, 27.934), P<0.001)], no formal antiepileptic treatment after the first operation [OR=0.160, 95% CI (0.050, 0.518), P=0.002], intra-operative suspended dural [OR=13.306; 95% CI (3.769, 46.976), P<0.001] and repair time of trauma >6 months [OR=6.205, 95% CI (1.705, 22.583], P=0.006] were independent risk factors of secondary epilepsy.ConclusionAfter decompression of bone flap, regular antiepileptic therapy, shortening repair time, and proper peroperative management can reduce the incidence of postoperative epilepsy.
【摘要】 目的 探讨难治性癫痫不同类型手术的预后与病程长短有无相关关系。 方法 回顾性分析2005年1月-2009年12月在四川大学华西医院神经外科进行难治性癫痫手术的143例患者，根据Engel分级对预后进行评估，分别分析各类型手术不同病程时间之间的预后差异以及相关关系。 结果 不同病程组颞叶手术和颞叶合并颞叶外手术的预后差异无统计学意义（Pgt;0.05），两者之间无相关关系；颞叶外手术的预后在不同病程组间差异有统计学意义（Plt;0.05），两者之间呈负相关。 结论 颞叶外癫痫手术的预后与病程存在相关关系；病程越短，预后越好。【Abstract】 Objective To discuss the relationship between prognosis of different intractable epilepsy surgeries and the disease course. Methods A total of 143 patients who had undergone surgeries for intractable epilepsy in the Neurosurgery Department of West China Hospital of Sichuan University from 2005 to 2009 were enrolled, and the prognosis with different disease course were assessed based on the Engel classification. Results Between different disease duration groups, the difference between the prognosis of the temporal surgery and the surgery of temporal lobe combined with other lobes was not statistically significant (Pgt;0.05), which indicated no relationship between the disease course and the prognosis. However, the difference between the prognosis of the surgeries outside the temporal lobe was statistically significant (Plt;0.05), which showed that patients with a longer disease course had a worse prognosis. Conclusion The prognosis of the epilepsy surgery outside the temporal lobe is correlated with the disease course. The shorter course has a better prognosis after surgery.
Objective To discuss the correlation between glutamate receptor 5 (GLUR5) and the pathogenesis of intractable temporal lobe epilepsy (ITLE), through detecting the GLUR5 expression in human with ITLE and Coriaria lactone-induced rhesus monkey temporal lobe epilepsy model. Methods Fifty-four patients with ITLE treated in West China Hospital between January 2007 and December 2015 were regarded as clinical case group in this study. The other 43 patients who underwent temporal lobe removal decompression surgery in the same time period due to trauma, tumor or large area cerebral hemorrhage complicated with cerebral hernia were designated as the clinical control group. Quantitive polymerase chain reaction (PCR) and Western blot methods were used to detect mRNA and protein levels of GLUR5. Western blot was also used to detect the GLUR5 protein level in the hippocampus and temporal lobe tissues of Coriaria lactone-induced rhesus monkey epilepsy model, and the result was compared with that of animal controls. Results Quantitive PCR results showed that the expression ratio (R value) of GLUR5 in the temporal lobe of the clinical case group to the clinical control group was 0.262, without significant difference (P>0.05), while theR value in the hippocampus was 4.896, with a significant difference (P<0.05). The amplification curve showed that the GLUR5 level in the hippocampus of the clinical case group was higher than that of the clinical control group, but the GLUR5 mRNA level in the temporal lobe tissue was not significantly changed. GLUR5 PCR amplified product electrophoresis showed that the amplified fragment was 161 bp. Western blot analysis showed that the GLUR5/actin value of the temporal lobe tissue in the clinical case group was 2.172±0.063, while the value in the clinical control group was 2.142±0.060, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the hippocampus in the clinial case group was 2.548±0.509, while it was 1.584±0.415 in the clinial control group, and the difference was statistically significant (P<0.05). The GLUR5/actin value of the hippocampus of the rhesus monkey model of epilepsy was 1.007±0.034, and it was 1.001±0.032 in the animal control group, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the temporal lobe tissue in the animal experimental group of rhesus model of epilepsy was 0.763±0.026, and it was 0.742±0.034 in the animal control group, and the difference was not statistically significant (P>0.05). The target protein bands showed that GLUR5 protein expression in the temporal lobe tissue and hippocampus of the rhesus model of epilepsy and animal controls was not significantly different (P>0.05). Conclusions GLUR5 participates in the pathogenesis of human ITLE by acting on the hippocampus. The expression of GLUR5 in human ITLE is abnormal, but the expression of GLUR5 is not changed in the rhesus model of epilepsy. The abnormal expression of GLUR5 may play a role in the pathogenesis of ITLE.
目的 利用磁共振弥散张量成像技术（DTI）对右侧难治性颞叶癫痫（TLE）患者术前及术后脑白质各向异性分数（FA）进行纵向随访研究，并对其与病程等临床症状之间的相关性进行分析，探讨右侧TLE患者的脑白质FA变化模式。 方法 2008年7月－2009年8月纳入10例右侧难治性TLE患者。对每个受试者采用GE 3.0 T磁共振及8通道头线圈扫描，所有DTI图像通过单次回波平面成像序列采集。采用基于体素分析的SPM8软件对受试患者术前术后FA图进行配对t检验，观察难治性TLE患者脑白质变化模式。采用Pearson相关计算FA变化幅度与病程等临床症状之间的相关性，经比较校正后P值＜0.05的区域为有统计学意义的区域。 结果 右侧TLE患者FA值降低的区域包括左侧颞下回、双侧额中回及左侧壳核、右侧楔叶。FA升高的区域包括左侧海马旁回、左侧颞叶、右侧额下回和左侧中央旁小叶。相关分析发现，右侧TLE患者右侧额下回FA变化值与发病年龄呈负相关，左侧颞下回FA变化值与术后随访间隔时间呈负相关。 结论 右侧难治性TLE患者手术治疗后大脑白质变化不仅局限于颞叶，还涉及颞叶外结构。