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Objective:To investigate the value of stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) in patients with focal epilepsy.Methods:Eighteen patients with focal epilepsy admitted to and treated by SEEG-guided RFTC in our hospital from April 2019 to December 2020 were chosen. The clinical data of these patients were retrospectively analyzed, and follow up was performed monthly by telephone and outpatient subsequent visit. The treatment efficacies of these patients were evaluated by Engel grading.Results:(1) The number of electrodes accurately implanted into the intended target in these 18 patients was 4-11 (6.56±2.15 on average); unilateral implantation was noted in 6 patients, and bilateral implantation was noted in 12 patients. SEEG monitoring showed that 7 patients were with frontal lobe epilepsy, 8 were with temporal lobe epilepsy, 2 were with frontotemporal junction epilepsy, and one was with temporal occipital junction epilepsy. (2) Two-9 RFTC electrodes (3.43±1.47 on average), and 9-42 RFTC contacts (17.38±9.20 on average) were given in these 18 patients. One patient developed seizures during the course of RFTC, one had temporary mental symptoms after RFTC, one had diffuse brain edema with intracranial hypertension, and one had asymptomatic regional brain edema. The total complication incidence was 22.2% (4/18) and no permanent neurological impairment occurred. (3) Eleven patients (61.1%) had recurred seizure within 1 year of RFTC: 3 (27.3%) recurred within 1 month, 3 (27.3%) recurred within 1-3 months, 3 (27.3%) recurred within 3-6 months, and 2 (18.2%) recurred within 6-12 months; however, the duration and frequency of seizure were obviously decreased as compared with those before RFTC. Seven patients (38.9%) received craniotomy after RFTC; follow up for 5-24 months showed that 12 patients were with Engel grading I, 4 were with Engel grading II, 2 were with Engel III, and no one was with Engel grading IV.Conclusions:SEEG-guided RFTC has enabled patients with focal epilepsy to achieve complete remission of their seizures with varying durations, and some patients have achieved long-term remission of their seizures. For patients with recurrent epilepsy after SEEG-guided RFTC, further craniotomy of the epileptogenic area is still effective.
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Objective To discuss the effect of posterior quadrant disconnection surgery on temporoparietooccipital intractable epilepsy.Methods A retrospective review of clinical,neuropsychological,EEG,imaging and histopathological data of 3 patients with intractable epilepsy,admitted to and underwent posterior quadrant disconnection surgery in our hospital from February 2012 to October 2013,was performed.Results The clinical manifestations of 3 patients were simple partial seizures generalized seizures secondary to partial seizures and generalized tonic clonic seizures.MRI examination showed that 3 patients were porencephaly,white matter dysplasia,and gray matter heterotopia.Patients were treated with right posterior quadrant disconnection surgery after general anesthesia.Follow up of 32,12 and 29 months was respectively performed in these 3 patients.The seizure control result after surgery was Engel Ⅰ in 2 patients and Engel Ⅱ in one patient.There was no new prolonged neurological deficit or death.Conclusion Posterior quadrant disconnection surgery is an effective method for posterior quadrant intractable epilepsy,which results in similar excellent early seizure control as hemispherectomy.
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Objective To determine the utility of apparent diffusion coefficient (ADC) values as an objective method of early detection of traumatic brain injury of the mice models in hippocampus injury.Methods A total of 18 healthy male adult C57/BL6 mice were randomly divided into three groups according to the degree of injury:the mild group,severe group and control group.Conventional images,diffusion-weighted images,ADC were studied.The hippocampal were selected as the interesting area.ADC values were calculated and compared with those in control subjects after 6 h,12 h and 24 h.Student t test was performed for each region to compare the injury groups and the control.Results In control group both sides hippocampal ADC values had no differences(8.65±0.26 and 8.77±0.12) × 10-4 mm2/s,P＞0.05.Abnormalities were detected on ADC values,compared with conventional images in the injury groups.ADC values in mild group and severe group were significantly different from those of control group(6 h ADC values were (8.70±0.50) × 10-4 mm2/s,(6.13± 0.11) × 10-4 mm2/s,and (3.16±0.78) × 10-4 mm2/s in control,mild and severe group respectively),(12 h ADC values (8.23±0.61)× 10-4 mm2/s,(5.92 ± 0.27) × 10-4 mm2/s and (2.64±0.65) × 10-4 mm2/s) and (24 h ADC values (9.01±0.14) × 10-4 mm2/s,(5.99± 0.13)×10-4 mm2/s and (2.58±0.42)×10-4 mm2/s),P＜0.05.Conclusion There are differences among the ADC values on differcnt types of hippocampal brain injury mouse-model.ADC values can identify the degree of damage on brain injury and can detect early craniocerebral injury.