Localization Value Of VEEG,MRI And MRS In Surgical Treatment Of Temporal Lobe Epilepsy

Background and purpose: Epilepsy is a chronic encephalopathy,and a considerable number of patients are refractory to drugs.Frequent seizures can cause serious neurological dysfunction and do much harm to patients themselves,families and society.Our country has vast territory and unbalanced regional economic development.The current situation of epilepsy surgical treatment is quite different in our country.How to use limited medical resources to make timely and effective surgical treatment for those intractable epilepsy patients,especially those with poor economic conditions,seems very necessary.The purpose of this study is to explore the economic and practical preoperative assessments like video electroencephalogram(VEEG),nuclear magnetic resonance(MRI),magnetic resonance spectroscopy(MRS)and so on,as well as their application value in temporal lobe epilepsy.Methods: Collect the datas of temporal lobe epilepsy patients who received surgical treatment in the department of neurosurgery of our hospital from January 2009 to July 2017 and finally 49 cases were included in the study.The clinical datas of these patients,including the medical history,clinical manifestation,preoperative examination results like MRI,MRS,VEEG,PET-CT and intraoperative ECoG,deep electrode tracings,postoperative follow up datas,are taken into retrospective analysis.All patients were followed up by telephone inquiries and outpatient visits according to the Engel criteria.According to the follow-up results,we analyzed the preoperative localization value of MRI,MRS and VEEG in epileptic surgery.And based on the existing conditions in our hospital,we discuss the promotion value of relevant preoperative evaluation methods in practical application.Results: of the 49 patients,there were 30 males and 19 females,aged from 5 to 59 years,with an average age of 27.6 years.The course of disease was from 2 to 30 years,with an average of 8.7 years.VEEG,MRI and MRS examinations were down in all 49 patients before operation.Each patient performed 3 times VEEG examinations before operation respectively in different date,in order to facilitate the comparative analysis,as well as to increase the probability of capturing the ictal EEG.The results were interpreted by the professional electrophysiological radiologist.Determined classification: can be localization or lateralization(focal or unilateral);can not be localization or lateralization(non side or systemic).The results showed that 9 of the 49 patients recorded ictal EEG during the 3 examinations,while the other 40 patients did not catch the ictal EEG,but the interictal EEG was recorded.Final analysis showed that among the 49 patients,abnormal discharge was located unilaterally in 42 cases and 7 were bilateral.The MRI scan showed 44 cases of abnormal signal and 5 cases with negative scan.49 patients received MRS examination.The results showed that 25 cases were abnormal in the hippocampus.10 patients received PET-CT examination,all of which were low metabolic manifestations of the epileptic foci during the interval of the seizure.All patients were operated on microsurgery under ECoG and deep electrode monitoring.The postoperative follow-up was undergone 6 months to7.9 years.The results showed that there were 26 cases achieved Engel grade I,15 cases of grade II,5 cases of grade III,and 3 cases of grade ?.Statistical analysis showed that there was no statistical difference between MRI and VEEG in different groups(P>0.05),but there was a statistical difference between the two groups in the combination of the two groups(P<0.05).In this study,MRS and PET-CT results were not statistically analyzed.Conclusion:1.The effect of surgical treatment on temporal lobe epilepsy is significant.VEEG and MRI can be used as the most basic methods for preoperative assessment.MRS is more sensitive to hippocampal sclerosis than MRI,and can improve the detection rate of hippocampal sclerosis,which is of great value in medial temporal epilepsy.2.The low cost of VEEG,MRI and MRS can benefit the temporal lobe epilepsy patients with poor economic conditions and accurate localization of epileptic foci.