The Study Of Localization And Mechanism In Children Intractable Epilepsy

[Objective]It is critical to have a precise localization for surgical treatment of intractableepilepsy.Weuse positron emission tomography (PET-CT), video electroencephalogram(VEEG), brain magnetic resonance (MRI) three inspection technology. The aim ofresearch is the clinical significance of three inspection technology on treatment ofrefractory patients.Further,we disscuss the clinical vaue on comprehensive evaluationof PET-CT, VEEG and MRI check three children with refractory epilepsy focuslocalization and operation, so as to select the optimal inspection method; To study theexpression of r-GABA in the brain tissue of Intractable Epilepsy patient, we observeγ-aminobutyric acid (γ-GABA) expression in the brain of refractory epilepsy inchildren, and explore its possible role in the process of leading diease.[Methods]1. Part1:30cases of intractable eilepsy in children which were collected fromAugust，2011to March，2012undergoing in Epilepsy Research and Treatment Centerof Fuzhou General Hospital were included in this study. The brain tissue wereresected by operation microscope, and the pathologic diagnosis.On VEEG and MRItwo examination, and results were compared with pathological results, andpostoperative follow-up for half a year, we observe the postoperative curative effect.The PET-CT, VEEG, MRI three examination, and results were compared withpathological results, and postoperative follow-up for half a year, we observe thepostoperative curative effect too. one method is taking two inspection methods andthe other method is taking three screening means. we will make a comparison for thepostoperative efficacy between the two methods.2. Part2:15child-Patients come from the Epilepsy Research and TreatmentCenter of Fuzhou General Hospital.15patients were localized by PET/CT, MRI andVEEG and clinical symptomatology assessment integrated positioning method before the operation, determine the epileptogenic zone parallel neurological surgeryoperation resection of epileptogenic focus treatment, then brain tissue of temporaloperation resection of lobe cortex specimens (experimental group) and brain tissuewere resected in8cases without history of epilepsy in children operation (4cases ofbrain tumor and4cases of brain hematoma)(control group) were compared.Immunohistochemistry(pv-9000) was used to detect the expression of r-GABA in thesurgically removed temporal cortex specimens of brain tissue of the patients withIntractable Epilepsy (n=15), and the results were compared with that of controltissue (n=8). At the same time, the experimental group were observed temporalcortex light microscopy (x100, x200) of other pathological changes.Using SPSS13statistical software packages for data processing, all inspection are both hypothesistesting, measurement data to S, measurement data by using two independentsamples t test, count data by using t test. P <0.05for the difference was statisticallysignificant.[Results]1.In30cases,24cases underwent PET/CT, VEEG and MRI examination, threelesion position consistent in14cases, operation efficiency of91.5%.There were6patients with VEEG and MRI examination, the lesion localization consistent in4cases, operation efficiency of66.7%.2. The experimental group compared with the control group, the experimentalgroup positive cell number was116.04±30.58, control group positive cell number191.78±79.65, the experimental group gamma GABA neurons expression leveldecreased significantly compared with the control group, the difference wasstatistically significant (P <0.05). The experimental group temporal cortex visibleneuronal loss, gliosis, degeneration and mast, projection increased, some glial cellprocesses woven mesh, temporal lobe cortical layers of GAD67immunohistochemical staining, cortical cell hierarchy disorders, subcortical structuresdysplasia associated with immature neurons, perivascular lymphocytic infiltration,cortex edema associated with small softening range and histopathological change of formation.[Conclusions]1. The research shows various techniques are studied only from differentaspects of epilepsy seizures,there are both advantages and disadvantages. so not onlyby a technology to give a clear positioning,we should be based on clinical findings,clinical seizure types, electrophysiological and selectively do auxiliary examinations.PET/CT, VEEG, MRI three joint examination for preoperative localization ofepileptogenic focus has a great significance and a useful application value onguiding the accurate localization of epileptogenic focus before operation. On thepreoperative determination of operation scheme has a better effect.Operationtreatment of epilepsy with satisfactory results.2. The study revealed that glial cells morphological changes, changes inneuronal cell number, morphology of the most likely is one of the pathogenesis ofrefractory epilepsy in children.3. At the same time, pathology can also be observed in cortical dysplasia,cortical structure, neural, vascular disorders, peripheral nerve infiltration and otherpathological changes, these pathological changes are likely to be one of thepathogenesis of refractory epilepsy in children.4. The immunohistochemical staining showed that the experimental group andthe control group were observed in the cytoplasm of neurons in the positive stainedcells, showing the r-GABA ergic neurons express, the number of experimental groupwas significantly lower than the control group.5.The number of experimental group was significantly lower than that of thecontrol group, suggesting that they might be certain relationship exists and play animportant role between the occurrence and intractable epilepsy.