Clinical Research Of Repairing The Epilepsy Patients With Early Hippocampal Sclerosis

Objective:In the patients with intractable epilepsy and temporal lobe epilepsy,hippocampal sclerosis is the most common nerve pathological change.Hippocampal sclerosis(HS),also called the medial temporal lobe sclerosis,loss is the main pathological characteristics of neurons and glial cells proliferation.Regular 3.0 T MRI scan(Magnetic Resonance Imaging,MRI)can show the size and the change of the signal,but the hydrogen proton nuclear Magnetic Resonance spectrum(Magnetic Resoance Spectroscopy,1H MRS)is a kind of quantitative analysis in the brain tissue biochemical metabolic abnormalities of new technologies,volume and can be found on the MRI signal changes can be showed mild abnormal[1],can be more early,more sensitive in the diagnosis of hippocampal sclerosis.The Single Photon Emission Computed Tomography,(SPECT)has more fault in finding the epileptogenic zone compared with MRI,but SPECT finds more hippocampal sclerosis compared with MRI[2].This study on conventional MRI and 1 h-MRS it for people with epilepsy,hippocampal sclerosis after antiepileptic drugs(AEDs)and"cocktail therapy" routine MRI before and after the treatment,1 h-MRS,SPECT,and EEG,to observe the hippocampal sclerosis after medical treatment in the case of a change in the inspection before and after treatment,and to explore the mechanism to change.Methods:The present study was performed in 47 epilepsy patients with hippocampal sclerosis who were diagnosed at the Second Hospital of Lanzhou University,Epilepsy Center,from january 2013 to january 2014.These patients first check the regular 3.0 T-no obvious abnormal MRI and 1H-MRS line suggesting the hippocampal sclerosis and SPECT and EEC examination,and 3 to 6 months after the review head 3.0 T magnetic resonance imaging(MRI),1H-MRS,SPECT and EEG.1H-MRS are suggestive of hippocampal sclerosis male 29 cases in 47 patients with epilepsy,18 were female,aged 5～34,an average of 15 years old.Course Ⅰ～Ⅱ years,an average of 3.4 years.Clinical manifestations of the overall stiffness clonus attack attack type 28 cases,simple partial seizure in 3,6 patients with complex partial seizure,simple partial onset seizures secondary comprehensive stiffness matrix cramps seizure in 4 cases,complex partial seizures secondary comprehensive stiffness matrix twin seizure,4 cases of simple partial onset seizures secondary complex partial seizure and secondary comprehensive stiffness matrix twin attacks in 2 cases.Etiology is 26 cases in 47 patients(55.3%),18 cases,from a single cause several causes and 8 cases.All of the patients the shortest march with no attack,up to five years,an average of 26.6 months,all not completely controllers are left out in this study.This study in patients with a single drug treatment of 35 cases(72.3%),and on antiepileptic drug therapy at the same time give"cocktail" therapy,before and after treatment for 3 to 6 month line of conventional MRI,1H-MRS,SPECT and EEG examination.Routine MRI examination requirements into the group of patients with hippocampal volume size,signal intensity,temporal Angle size,and so on are normal hippocampus,hydrogen proton nuclear magnetic resonance spectrum main observation NAA/(Cr+ Cho)value changes and analyzed;Main observed abnormal SPECT perfusion status of the oven,location and the change of before and after treatment;EEG is mainly observed in patients with abnormal discharge quantity,place and the change of before and after treatment.Results:In this study,47 cases of epilepsy patients during hospitalization were "cocktail"therapy.By 1 h-MRS hint NAA/Cr + Cho)values to reduce early(<0.68)in the diagnosis of hippocampal sclerosis.47 cases of patients with hippocampal atrophy sclerosis of the antiepileptic drug oral and intravenous drip "cocktail" therapy after treatment,the review 1h-MRS results showed that after treatment of NAA/Cr(+ Cho)restored normal ratio of 18 cases(38.3%),not restore normal has 29 cases(61.7%),and after the treatment ratio increased from the previous 16 cases(34.0%);To further reduce the 13 cases(33.1%).In general,the previous improvement in 34 cases(72.3%),statistically significant difference(chi-square = 19.848,P<0.05).Look from the distribution of hippocampal sclerosis position,treatment before the left hippocampal sclerosis in 47 patients with hippocampal sclerosis 21 cases(44.7%),9 cases(19.1%)on the right side,double side of 17 cases(36.2%).After treatment of 29 patients with hippocampal sclerosis left hippocampal sclerosis in 12 cases(41.4%),5 cases(17.2%)on the right side,double side 12 cases(41.4%).Normal treatment SPECT imaging before 15 cases(31.9%),abnormal perfusion stove is 32 cases(68.1%),abnormal perfusion oven before and after the treatment reduced the 21 cases(65.6%),statistically significant difference(X squared = 31.822,P = 31.822<0.05).EEG before treatment no obvious abnormal in 16(34.1%),with obvious epileptiform discharge is 31 cases(65.9%),including focal discharge in 22 cases(46.8%),generalized abnormal in 9(19.1%),normal electroencephalogram(EEG)32 cases(68.1%),after treatment has obvious epileptiform discharge in 15 cases(31.9%),which limits discharge in 9 cases(60.0%),generalized abnormal in 6(40.0%).Electroencephalography(eeg)before and after the treatment was abnormal 16 cases(51.6%),reduced the differences statistically significant(X squared-9.542,P<0.05).Conclusion:Early hippocampal sclerosis 1H-MRS can show the NAA/Cr(+ Cho)value decreases,"cocktail" therapy in combination with antiepileptic drugs can improve the metabolism of neurons by function and mitochondrial function,so as to make the 1H-MRS hint of hippocampal sclerosis NAA/early(Cr+Cho)ratio fell to a certain degree of recovery;Epilepsy patients with hippocampal sclerosis may reverse and hippocampus magnetic resonance spectrum NAA/ratio(Cr + Cho)more likely to recover when close to normal;Low perfusion SPECT in the temporal lobe can be early early changes of hippocampal sclerosis,and 1H-MRS,NAA/Cr(+ Cho)closely related to value decreases.