The Clinical And Brain Network Research Of Stereoelectroencephalography Guided Radiofrequency Thermocoagulation For Treatment In Epilepsy

Epilepsy is a series of clinical syndromes resulted from abnormal synchronous discharge of brain neurons.As for drug resistant epilepsy,surgery can generally acquire a better outcome.At present,stereoelectroencephalography is extensively applied because it can better localize the epileptogenic zone depending on the combination of anatomy,electroencephalography and clinical symptoms.SEEG-guided radiofrequency thermocoagulation(RFTC)just grows in China,which has a larger development space and application prospect.About the mechanism of SEEG-guided RFTC,the research put forward three hypotheses.One is that thermocoagulation maybe lesion the neuron,wipe out the abnormal discharge;one is that thermocoagulation maybe lesion the nerve fibers and block the propagation of abnormal discharge;another is that thermocoagulation maybe change the topological attributes of the brain network,and further change the brain function.The study includes four parts.The first part is some experiment researches.These experiments consist of the RFTC experiment on egg white,isolated human brain,and the RFTC observational experiment on pork,living human brain.Some appropriate RFTC parameters and technical key points are concluded.It turns out that the volume of RFTC lesion is related to RF power and duration.The stronger the power is,and the longer the duration is,the larger the volume will be within a certain range.The second part is clinical research,which summarizes some seizure frequency before and after RFTC,determine the optimal indication,contraindication and technical parameter.The effect following-up was smoothly completed.The third part is mechanism research.The RFTC mechanism is deeply investigated from three angles of diffusion tensor imaging(DTI),brain structural and functional network.DTI research finds that there is fractional anisotropy(FA)decrease and mean diffusion(MD)increasement in epileptics compared with normal subjects.All fibers through the RFTC targets nearly drop off,which further deduce that the brain network consisted of the gray matter and white matter possibly alters.The brain network research shows that there are some network topological attributes changes in many other brain areas apart from temporal lobe in the temporal epileptics group compared with the normal subjects group,and that the network topological attributes changes mainly focus on the right temporal lobe after RFTC.This part also includes the research that the epileptogenic zone is localized by brain network.In the end,cortex-cortex evoked potential(CCEP)research indicates that the brain functional network based on electroencephalography has changed after RFTC.The major innovative points are that:1、The common bipolar coagulation generator is utilized to make RFTC;2、RFTC undergoes between adjacent electrodes;3、The RFTC mechanism is deeply investigated from three different angles of diffusion tensor image(DTI),brain structural and functional network;4、Brain network is utilized to localize the epileptogenic zone.Finally,the research argue that SEEG-guided RFTC can be as one kind of routine minimally invasive method to treat drug resistant epilepsy,which is safe,reliable,and feasible.In addition,brain network contribute to localize the epileptogenic zone.