Xiao Gang (pseudonym), a 16-year-old from Hunan Province, began to have episodic delirium, upward turn of the eyes, and convulsions of the limbs from the age of 3, and the duration was 1-3 minutes to relieve and recover on its own. Although Sought by a number of large hospitals, taking oxcarbazepine, magnesium valproate and other drug treatment is still frequent, manifested by laughing for no reason, walking around aimlessly, at that time unconscious disorder, the seizure time is seconds to minutes, more than 10 times a week or daily.
In order to further systematic diagnosis and treatment, he came to the Epilepsy Center of the Second People's Hospital of Hunan Province (Hunan Provincial Brain Hospital), and the deputy chief physician Wang Qin received the diagnosis, and after completing several video EEG, brain MRI scan, brain PET-CT and other examinations and evaluations during hospitalization, the diagnosis was "symptomatic refractory epilepsy (focal seizures, obsessive laughter attacks), hypothalamic hamartomas" after discussion by Lu Jun, chief physician of the MDT team, Deputy Chief Physician Li Zhenguang, Deputy Chief Physician Wang Qin, and Attending Physician Peng Qiong.
After general anesthesia intubation, "stereotactic intracranial deep electrode implantation" and "hypothalamic hamartoma stereo EEG deep electrode reversible radiofrequency destruction", the epileptic abnormal discharge caused by epileptic fever coagulation radiofrequency destruction. Since 1 month after the operation, the effect has been remarkable, and the patient has not had a seizure.
Stereotactic EEG electrode implantation
Lu Jun, chief physician of the Epilepsy Center of the Second People's Hospital of Hunan Province (Hunan Brain Hospital), explained that demented epilepsy is clinically rare and belongs to focal epilepsy, and hypothalamic hamartoma is the most important cause. Clinical manifestations are characterized by episodic smirking and inability to control themselves, which stop abruptly for several seconds or tens of seconds each time, can occur dozens of times a day, and can also appear other types of seizure symptoms as the disease progresses. The disease is indeed determined mainly based on sudden, repetitive, transient laughter for no reason, and EEG finding epileptiform wave discharge.
Regarding the treatment, Director Lu further explained that the effect of drug treatment of demented laughter epilepsy is poor, and most of them belong to drug-resistant refractory epilepsy. Surgical treatment for etiology tends to achieve better results. However, due to the deep location of the lesion and the large number of important results around it, the difficulty of craniotomy and the risk of trauma are large. However, stereotactic EEG-guided radiofrequency thermal coagulation is a kind of electrode detractation and radiofrequency destruction surgery based on stereotactic EEG, and the treatment of radiofrequency thermal coagulation lesions after SEEG electrode implantation can accurately locate the lesion and damage the deep epilepsy foci, cut off the epilepsy network, and is a minimally invasive treatment method for the treatment of drug-resistant refractory epilepsy, precise treatment, minimally invasive and safe, and will not cause neurological damage.
Contributed by: Li Zhenguang, Wang Qin, Epilepsy Center, Second People's Hospital of Hunan Province
Editor: Liu Yuchen
Photo: Li Zhenguang Wang Qin