MRS,VEEG And ECoG Were Combined To Comprehensive Localization Of Epileptogenic Foci In Temporal Lobe Epilepsy And Evaluate The Surgical Efficacy

Objective:To explore the diagnostic value of combination of VEEG(video EEG monitoring)and MRS(MR spectroscopy)in locating epileptic foci in TLE patients and combined with intraoperative cortical electroencephalogram(ECoG)to guide the curative effect of surgical resection of epileptic focus on TLE.Methods:During the medical records from TLE patients who had clinical symptoms of seizure and eeg results of different hospitals during 2016.01 to 2017.12in the third people's hospital of bengbu epilepsy research institute according to the international union of antiepileptic possible diagnostic criteria of diagnosis of TLE patients,on the basis of screening cases and exclusion criteria,were retrospectively analyzed in 138 patients.The 138 patients included in the study were divided into focal epilepsy and unexplained epilepsy according to the secondary etiology of epilepsy.VEEG and MRS were used to detect the epileptogenic focus of TLE patients with different etiology.Among the 138 cases of epilepsy secondary to temporal lobe lesions included in the study,VEEG and MRS tests were also completed.23 cases of TLE secondary to temporal lobe lesions with complete medical records were selected for surgical treatment according to the inclusion and exclusion criteria.Combined with ECoG during the operation,epileptic lesions were detected to guide the surgical resection range,and the postoperative effect was evaluated by Engel standard.Results:In the application of VEEG and MRS tests to loci of epileptic foci in patients of different etiology groups,a total of 41 cases of patients in the focus group had a fit with the abnormal signal location of MRS,with a fit degree of 58.57%.A total of 23 patients in the unexplained group had a fit with the abnormal signal location of MRS,with a fit degree of 35.94%,Afterc~2 test,c~2=7.858,P=0.005,the difference was statistically significant.In comparison with MRS and VEEG location-based epileptic foci during the operation under the guidance of ECoG retesting,the consistent rate of MRS and ECoG was 95.65%,and the consistent rate of VEEG and ECoG was 65.22%.Afterc~2 test,c~2=6.769,P=0.009,the difference was statistically significant(P<0.05).Again in ECoG detection under the guidance of 23cases of surgical treatment of TLE patients,postoperative follow-up of 12 to 27months,according to Engel evaluation criteria,the result shows:Engel?18 cases,Engel?level 3 cases,Engel?level 1 case,Engel?level 1 case,no serious postoperative complications and death cases,postoperative clinical effect is effective,a total of 21 cases,the significantly effective rate was 91.3%.Conclusion:1.VEEG and MRS are both important examination methods in the diagnosis and location of epilepsy,and each has its own advantages.VEEG is mainly used in the diagnosis of epilepsy,but the accurate location of epileptic foci is still insufficient.MRS can sensitively detect abnormal changes in biochemical components in abnormal brain tissues with neuroelectrophysiological changes,which can effectively make up for the deficiency of VEEG in determining the side and location of epileptic foci.2.VEEG and MRS were used for epilepsy in the focus group and the unexplained group,and it was found that the location of epileptic foci in the focus group was consistent.3.Combined with ECoG during the operation to detect the epileptic foci and guide the surgical resection range,the effect of surgical treatment can be significantly improved,and the postoperative effect of TLE patients is significantly effective up to91.3%.4.For patients requiring surgical treatment under general economic conditions,preoperative application of comprehensive positioning of MRS and VEEG for epileptic focus and intraoperative ECoG redetection of epileptic focus is a good choice for patients with temporal lobe lesions secondary to TLE,which can avoid expensive examination costs and obtain satisfactory curative effect.