【摘要】 目的 探讨用视频脑电图和MRI诊断药物难治性癫痫的临床价值。 方法 收集2006年12月-2010年5月间经手术和病理证实的药物难治性癫痫患者38例。其中，海马硬化25例，颞叶萎缩伴脑发育不良2例，脑灰质移位及巨脑回4例，血管畸形3例，胶质瘤2例，脑内囊肿1例，外伤性癫痫1例。用视频脑电图监测癫痫发作期及发作间期痫样放电的来源部位及脑电活动特点，用MRI扫描显示痫灶区的表现特征，并与手术、病理改变对照，进行回顾性分析。 结果 视频脑电图对癫痫发作期的致痫灶来源定位准确率为100%（38/38），发作间期定位准确率为53%（20/38）。MRI对发作间期的致痫灶及相关病变定位诊断准确率为89%（34/38），病变定性准确率为79%（30/38）。 结论 视频脑电图和MRI检查有机结合，对药物难治性癫痫，能更有效检出致痫灶的部位及性质，为药物难治性癫痫患者的手术治疗，提供重要信息。【Abstract】 Objective To study the clinical diagnosis value of video-electroencephalography (EEG) and MRI on pharmacal intractable epilepsy. Methods From December 2006 to May 2010, 38 cases of pharmacal intractable epilepsy were confirmed through operation and pathologic examination. Among them, there were 25 cases of hippocampal sclerosis, 2 cases of temporal lobe atrophy combined with brain dysplasia, 4 cases of heterotopic gray matter and macrogyria, 3 cases of vascular malformation, 2 cases of glioma, 1 case of cyst in brain, and 1 case of traumatic epilepsy. Video-EEG was applied to monitor the source of epileptoid discharge and the features of brain electrical activity during and between the occurrences of epilepsy. MRI was used to detect the manifestation characteristics of the epilepsy focus, and retrospective analysis was done to compare these findings with operational and pathological results. Results The accuracy rate of Video-EEG in locating the epilepsy focus was 100% (38/38) during the occurrence of epilepsy, and 53% (20/38) between the occurrences of epilepsy. The accuracy rate of MRI in diagnosing the epilepsy focus and relevant abnormalities during the occurrence of epilepsy was 89% (34/38), and 79% (30/38) in characterizing the abnormalities. Conclusion Video-EEG combined with MRI examination is effective in locating and characterizing the epilepsy focus, which can provide more useful information for the surgery in treating pharmacal intractable epilepsy.
ObjectiveTo compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures.MethodsThe clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation.ResultsThe patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group (t=−11.965, P=0.000; t=−20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups (P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group (P>0.05), but there were significant differences in sitting and sexual intercourse scores (t=−4.250, P=0.003; t=−6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group (P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group (P<0.05).ConclusionCompared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.
ObjiectiveTo explore the efficacy and safety of ketogenic diet therapy (KDT) in the rapidly progressive stage of childhood developmental epileptic encephalopathy Dravet syndrome (DS). Methods The clinical data of all patients who added KDT in the Children’s Hospital of Fudan University from 2011 to 2022 were retrospectively collected, and the age of <6 years was used as the criterion for the rapid progression of the disease. The clinica data, genotype and the efficacy of KDT were analyzed in DS patients who met the criteria. Results A total of 32 patients met the criteria for rapid disease progress, including 22 males and 10 females. The age at onset was (5.69±2.10) months. All patients had multiple seizure phenotypes and monthly seizures despite reasonable Antiseizure medications treatment. After 3, 6, 12, and ≥24 months, 93.8% (30/32), 87.5% (28/32), 53.1% (17/32), 34.4% (11/32) remained on the KDT, while 76.7% (23/30), 75.0% (21/28), 70.6% (12/17), 54.5% (6/11) showed >50% reduction in seizure. Status epileptius (SE) was reduced by 100% at 3 months, 71.0% at 6 months, 86.0% at 12 months. After 12 months, 14 patients experienced efficacy degradation. After 3 months, the EEG background rhythm showed improvement in 75.0% patients, interictal epileptic discharges was decreased in 54.5% patients and cognitive function was improved in 78.6% patients. At the initial stage of KDT, 62.5% (20/32) patients had transisent adverse reactions, including diarrhea, vomiting, fatigue, lethargy, hypoglycemia, and metabolic acidosis, but no mid- and long-term adverse reactions were found. ConclusionKDT is an efficective and safe treatment for DS. KDT can effectively control seizures, reduce the incidence of Status SE and shorten the duration of SE. With the prolongation of the KDT course, some patients experienced a degraded effect. KDT can improve abnormal EEG and cognitive function in DS patients. Pharmoco-resistant DS patients are suggested to receive KDT in the early stage of disease progression.