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目的观察原发性颞叶癫痫经定向适形放射治疗后的近期疗效和长期随访结果,探讨适形放射治疗是否适用于原发性颞叶癫痫。方法自2003年4月～2004年12月间收治了11例原发性颞叶癫痫病人,以64-V-EEG的检查确定癫痫灶区域;同时经过MRI、脑磁图(MEG)、PET-CT等调整癫痫灶靶区的范围,用Win-MRT-TPS优化治疗方案,以85%～90%等剂量计算,立体定向适形放疗隔日治疗1次,每次600cGY,共2次,总量1200 cGY。病人随访3～5年,每次检查MRI、64-V-EEG,部分病人加查脑磁图(MEG)和PET-CT以评定疗效。结果治疗后患者症状逐渐缓解,6个月缓解5例,6～12个月缓解4例,2例未见效果。治疗后1年效果满意、显著改善、良好者9例,总有效率81.8%(9/11),3年77.8%(7/9),5年83.3%(5/6)。治疗后5例病人出现脑水肿,2例病人轻微头疼、恶心。7例病人局灶性脱发。结论适形放射治疗原发性颞叶癫痫患者后部分疗效良好,随访期内未发现明显不良反应,提示该方法是一种微创、有效的治疗方法。
Objective To observe the short-term efficacy and long-term follow-up of primary temporal lobe epilepsy after directional conformal radiotherapy and to investigate whether conformal radiotherapy is suitable for primary temporal lobe epilepsy. Methods From April 2003 to December 2004, 11 patients with primary temporal lobe epilepsy were enrolled. The epileptogenic zone was identified by 64-V-EEG examination. At the same time, MRI, MEG, PET- CT and other adjustments of the scope of the target range of epileptic foci, with Win-MRT-TPS optimized treatment program, with 85% to 90% of the dose calculation, stereotactic conformal radiotherapy every other day treatment once every 600cGY, a total of 2 1200 cGY. The patients were followed up for 3 to 5 years. MRI, 64-V-EEG, MEG and PET-CT were performed in each patient to evaluate the curative effect. Results The symptoms of patients were gradually relieved after treatment, 5 cases were relieved at 6 months, 4 cases were relieved at 6 ~ 12 months and 2 cases showed no effect. One year after treatment, the effect was satisfactory and significantly improved. Nine patients were good, with a total effective rate of 81.8% (9/11), three-year 77.8% (7/9), and five-year 83.3% (5/6). After treatment, 5 patients had brain edema, 2 patients had slight headache and nausea. Seven patients had focal alopecia. Conclusions Conformal radiation therapy is effective in partial treatment of patients with primary temporal lobe epilepsy. No obvious adverse reactions were observed during the follow-up period, suggesting that this method is a minimally invasive and effective treatment.