| Objective:At present,there are 5-6 million active epilepsy patients in China,accounting for more than 60%of the total number of epileptic patients,and the number of new patients is more than 650000 each year.According to clinical statistics,about 40%of patients are drug refractory epilepsy,and the use of antiepileptic drugs can not fully control epilepsy.The treatment of drug refractory epilepsy often depends on surgery.However,the latter needs to accurately locate the epileptic focus and completely remove the epilepsy focus,and fully protect the important functional brain areas such as body movement area,language area,audio-visual center,etc.if there is any injury,it may seriously affect the clinical effect and prognosis of the patients.Stereoelectronephalugraph(SEEG)can provide reliable,rich and three-dimensional information reference for the clinical epilepsy operation plan.It is difficult to get consistent conclusions before noninvasive stage ? operation to accurately locate the epileptic focus or bilateral attack.In invasive phase ? assessment,the important auxiliary information provided by SEEG has obvious advantages in the classification of the epileptic focus and the related necessary functional areas.Therefore,it is of great value to make full use of the information provided by SEEG in the preparation of the surgical plan for drug refractory epilepsy.Methods:This study reviewed the clinical evaluation of drug refractory epilepsy patients,based on stereotactic navigation technology and multimodal image fusion technology,designed the intracranial electrode implantation and surgical resection scheme,and comprehensively analyzed the SEEG monitoring results to guide the clinical epilepsy operation indication and the scope of resection plan.According to the results of SEEG monitoring,we adjusted the original operation plan and divided the patients into four groups.Group 1:the results were consistent,and the operation was performed according to the original plan;group 2:the results suggested that the epileptic area was completely different from the expectation,and the operation plan was re formulated;group 3:the results suggested that there was at least one far away epilepsy area except the main expected epileptic foci,and the operation was performed according to the original plan;group 4:the results suggested that bilateral origin or diffuse discharge could not be removed.In addition,patients were given corresponding antiepileptic drugs after operation,and we followed up them every 3 months.The patients were evaluated according to the classification system of epilepsy issued by the International Association Against Epilepsy(ILAE),and defined the 1-4 levels as improvement.Results:118 patients with refractory epilepsy who received surgical treatment were collected from the beginning of 2018 to the end of 2020.Due to the inconsistent results of phase I evaluation,48 patients were further examined by SEEG.Of the 48 patients,25 patients changed the original operation plan due to the results of SEEG monitoring and carried out a new surgical plan;in addition,the results of SEEG monitoring showed that 13 patients cancelled the original operation for bilateral or multiple focal origin(2 of them performed DBS implantation with bilateral deep hippocampal electrodes).In conclusion,the results of this SEEG monitoring changed the surgical plan of 38 patients with refractory epilepsy(79%).Conclusion:The results of this study confirm that the patients who are inconsistent in the preoperative evaluation of refractory epilepsy have significant influence on the further treatment plan after monitoring with SEEG.The results of SEEG monitoring can help to make personalized and accurate treatment plan... |
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