脑磁图联合Wada test在癫痫术前评估中的应用
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摘要
目的探讨脑磁图联合Wada test对癫痫患者语言和记忆功能术前评估的价值。方法回顾26例癫痫患者的术前痫灶定位和神经心理评估资料。患者联合应用脑磁图及Wada test确定语言、记忆优势半球,明确语言功能区范围和记忆功能情况,并指导手术治疗。对比分析术前与术后1年患者智商、记忆和语言功能变化。结果 26例癫痫患者脑磁图和Wada test检查过程顺利,均能确定语言功能区及记忆优势半球,20例语言优势半球为左侧,6例在右侧。14例记忆优势半球位于左侧,8例位于右侧,4例双侧半球。术后1年患者言语智商与总智商提高(P<0.05),记忆商、操作智商无明显变化(P>0.05)。记忆优势半球及非优势半球比较,记忆评分差异明显(P<0.05)。结论脑磁图能够精确定位语言功能区位置。Wada test可以评估患者记忆功能。脑磁图联合Wada test可在术前准确定位语言功能区位置,了解记忆功能情况,对指导手术切除范围,避免术后语言、记忆功能损伤具有重要意义。
Objective To investigate the role of MEG combined with Wada test in the assessment of language and memory function in epilepsy patients before surgery. Methods Twenty-six cases of epilepsy patients, preoperative localization of epileptogenic focus and neuropsychological assessment; the combination of MEG and Wada test, to determine the language memory, dominant hemisphere, clear language function area and memory function. IQ, Memory, language function of patients were compared before and 1 year after surgery. Results Twenty-six patients with epilepsy were checked by MEG and Wada test the process smoothly, can lateralization of language and memory of the dominant hemisphere, 20 cases of left hemisphere language dominance, 6 cases were located on the left side on the right side of the. 14 memory of the dominant hemisphere, 8cases located in the right hemisphere, 4 cases of bilateral.MEG can accurately locate the position of the. WADA language function can be evaluated in patients with memory comparison of memory function. The IQ, memory and language function were measured before and after 1 year. Verbal IQ and total IQ increased(P<0.05), and no significant change in memory quotient and operation IQ(P>0.05). The dominant hemisphere and non dominant hemisphere, memory score was significant(P<0.05). Conclusion Wada test recovered well after operation, without serious language and memory impairment. MEG combined with Wada test can accurately locate the lateral language, memory the dominant hemisphere, and understand the memory function before operation. It is of great significance for guiding the resection range and avoiding postoperative complications.
Objective To investigate the role of MEG combined with Wada test in the assessment of language and memory function in epilepsy patients before surgery. Methods Twenty-six cases of epilepsy patients, preoperative localization of epileptogenic focus and neuropsychological assessment; the combination of MEG and Wada test, to determine the language memory, dominant hemisphere, clear language function area and memory function. IQ, Memory, language function of patients were compared before and 1 year after surgery. Results Twenty-six patients with epilepsy were checked by MEG and Wada test the process smoothly, can lateralization of language and memory of the dominant hemisphere, 20 cases of left hemisphere language dominance, 6 cases were located on the left side on the right side of the. 14 memory of the dominant hemisphere, 8cases located in the right hemisphere, 4 cases of bilateral.MEG can accurately locate the position of the. WADA language function can be evaluated in patients with memory comparison of memory function. The IQ, memory and language function were measured before and after 1 year. Verbal IQ and total IQ increased(P<0.05), and no significant change in memory quotient and operation IQ(P>0.05). The dominant hemisphere and non dominant hemisphere, memory score was significant(P<0.05). Conclusion Wada test recovered well after operation, without serious language and memory impairment. MEG combined with Wada test can accurately locate the lateral language, memory the dominant hemisphere, and understand the memory function before operation. It is of great significance for guiding the resection range and avoiding postoperative complications.
引文
[1]李新宇,张伟,鲁杰.癫痫患者认知功能障碍及康复策略[J].中华物理医学与康复杂志,2013,35(3):233-4.
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[11]杨二娟,毓青,白学军,等.颞叶和额叶癫痫认知功能特点的研究[J].天津医科大学学报,2013,1(19):70-2.
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[13]Deling L,Nan J,Yongji T,et al.Intraventricular ganglioglioma prognosis and hydrocephalus:the largest case series and systematic literature review[J].Acta Neurochir(Wien),2013,155(7):1253-60.
[14]熊伟茗,但炜,王超,等.丙泊酚对癫痫发作患者致痫灶激化作用的研究[J].第三军医大学学报,2013,35(15):1570-3.
[15]Papanicolaou AC,Simos PG,Castillo EM,et al.Magnetocephalography:a noninvasive alternative to the Wada procedure[J].J Neurosurg,2004,100(5):867-76.
[16]任洁钏,乔慧,王群.脑磁图在癫痫术前定位中的应用进展[J].临床神经病学杂志,2017,4(30):314-6.
[17]郭韬,李文玲,武江,等.脑磁图描记联合术中唤醒用于显微镜下切除功能区胚胎发育不良性神经上皮瘤[J].第二军医大学学报,2011,32(2):198-201.
[18]Nazem-zadeh MR,Bowyer SM,Moran JE,et al.MEG coherence and DTI connectivity in mTLE[J].BrainTopogr,2016,29(4):598-622.
[19]Jehi LE,Palmini A,Aryal U,et al.Cerebral cavernous malformations in the setting of focal epilepsies:pathological findings clinical characteristics and surgical treatment principles[J].Acta Neuropathol,2014,128:55-65.
[20]VerrottiA,D’EgidioC,Agostinelli S,et a1.Antiepileptic drug withdrawal in childhood epilepsy:what are the risk factors as sociated、withl seizure relapse[J].Eur J Paediatr Neurol,2012,16(6):599-604.
[21]郭韬,梁传栋,吴玉锦,等.脑磁图联合DTI对大脑半球萎缩继发癫痫患者术前功能区评估的价值[J].中华神经医学杂志,2014,13(9):919-24.
[22]Curot J,Denuelle M,Busigny T,et al.Bilateral Wada test:amobarbital or propofol[J].Seizure,2014,23(2):122-6.
[23]江建东,谭启富,姚一,等.丙泊酚Wada试验在脑功能区病变术前评估中的应用[J].国际脑血管病杂志,2013,21(7):769-73.
[24]郭韬,刘倩薇,陈尧,等.脑磁图联合弥散张量成像在常规磁共振成像阴性的额叶局灶性皮质发育不良术前评估中的应用价值[J].中国全科医学,2015,18(6):729-32.
[2]Perucca E.Optimizing antiepileptic drug treatment in tumoral epilepsy[J].Epilepsia,2013,54(Suppl 9):S97-104.
[3]周辉,鲁明,贺小军,等.磁共振T2Flair像下扩大切除脑胶质母细胞瘤[J].分子影像学杂志,2017,3(40):251-6.
[4]曹纹平,赵春生.唤醒麻醉和术中直接电刺激在功能区继发性癫痫手术中的应用[J].江苏医药,2014,16(40):1876-9.
[5]Takayama M,Miyamoto S,Ikeda A,et al.Intracarotid propofol testfor speech and memory dominance in man[J].Neurol,200463(3):510-5.
[6]Mikuni N,Takayama M,Satow T,et al.Evaluation of adverse effects in intracarotid propofol injection for Wada test[J].Neurology,2005,65(13):1813-6.
[7]Bauer P R,Reitsma J B,Houweling B M,et al.Can fMRI safely replace the Wada test for preoperative assessment oflanguage lateralisation?A meta-analysis and systematic review[J].J Neurol Neurosurg Psychiatry,2014,85(5):581-8.
[8]Haag A,Knake S,Hamer H M,et al.The Wada test in Austrian,Dutch,German,and Swiss epilepsy centers from 2000 to 2005:a review of 1 421 procedures[J].Epilepsy Behav,2008,13(1):83-9.
[9]Curot J,Denuelle M,Busigny T,et al.Bilateral Wada test:amobarbital or propofol[J].Seizure,2014,23(2):122-8.
[10]Wada J,Rasussen T.Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance[J].J Neurosurg,2007,106(6):1117-33.
[11]杨二娟,毓青,白学军,等.颞叶和额叶癫痫认知功能特点的研究[J].天津医科大学学报,2013,1(19):70-2.
[12]Passarelli V,Pinto L F,Jorge C L,et al.The intracarotidetomidate Wada test:A 54-patient series[J].Epilepsy Behav,2014,39(1):73-7.
[13]Deling L,Nan J,Yongji T,et al.Intraventricular ganglioglioma prognosis and hydrocephalus:the largest case series and systematic literature review[J].Acta Neurochir(Wien),2013,155(7):1253-60.
[14]熊伟茗,但炜,王超,等.丙泊酚对癫痫发作患者致痫灶激化作用的研究[J].第三军医大学学报,2013,35(15):1570-3.
[15]Papanicolaou AC,Simos PG,Castillo EM,et al.Magnetocephalography:a noninvasive alternative to the Wada procedure[J].J Neurosurg,2004,100(5):867-76.
[16]任洁钏,乔慧,王群.脑磁图在癫痫术前定位中的应用进展[J].临床神经病学杂志,2017,4(30):314-6.
[17]郭韬,李文玲,武江,等.脑磁图描记联合术中唤醒用于显微镜下切除功能区胚胎发育不良性神经上皮瘤[J].第二军医大学学报,2011,32(2):198-201.
[18]Nazem-zadeh MR,Bowyer SM,Moran JE,et al.MEG coherence and DTI connectivity in mTLE[J].BrainTopogr,2016,29(4):598-622.
[19]Jehi LE,Palmini A,Aryal U,et al.Cerebral cavernous malformations in the setting of focal epilepsies:pathological findings clinical characteristics and surgical treatment principles[J].Acta Neuropathol,2014,128:55-65.
[20]VerrottiA,D’EgidioC,Agostinelli S,et a1.Antiepileptic drug withdrawal in childhood epilepsy:what are the risk factors as sociated、withl seizure relapse[J].Eur J Paediatr Neurol,2012,16(6):599-604.
[21]郭韬,梁传栋,吴玉锦,等.脑磁图联合DTI对大脑半球萎缩继发癫痫患者术前功能区评估的价值[J].中华神经医学杂志,2014,13(9):919-24.
[22]Curot J,Denuelle M,Busigny T,et al.Bilateral Wada test:amobarbital or propofol[J].Seizure,2014,23(2):122-6.
[23]江建东,谭启富,姚一,等.丙泊酚Wada试验在脑功能区病变术前评估中的应用[J].国际脑血管病杂志,2013,21(7):769-73.
[24]郭韬,刘倩薇,陈尧,等.脑磁图联合弥散张量成像在常规磁共振成像阴性的额叶局灶性皮质发育不良术前评估中的应用价值[J].中国全科医学,2015,18(6):729-32.