小儿病毒性脑炎继发癫痫的EEG影像学及临床分析

目的探讨儿童病毒性脑炎继发癫痫(PEE)的脑电图(EEG)及影像学特点,进一步探讨其临床高危因素。方法以明确诊断的34例PEE患儿为观察组,选取同时期就诊的同年龄段病毒性脑炎未继发癫痫(no-PEE)患儿102例为对照组。收集患儿病毒性脑炎(VE)急性期临床资料,并进行随访。结果单因素分析得出2组病脑急性期痫性发作≥2次、癫痫持续状态(SE)、昏迷,EEG癫痫样放电、广泛或弥漫性慢波,影像学单纯皮层受损、皮层及皮层下受损、丘脑基底节受损差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,病毒性脑炎急性期痫性发作≥2次、SE、昏迷、EEG癫痫样放电、影像学皮层及皮层下同时受损差异有统计学意义(P<0.05),为PEE危险因素。2组患儿随访期间智力发育落后差异有统计学意义(P<0.001)。结论病毒性脑炎急性期EEG癫痫样放电、影像学皮层及皮层下同时受损、痫性发作≥2次、SE、昏迷为PEE危险因素。PEE患儿远期多有智力发育落后,应密切随访,及时干预治疗。     

影响首次(癎)性发作后与复发间隔时间的危险因素

目的探讨影响首次癎性发作后与复发间隔时间的危险因素,以指导首次癎性发作后的治疗。方法回顾性分析667例发作至少2次以上癫癎患者的临床资料,应用单变量分析和Cox回归分析,建立比例风险度模型,判断影响首次癎性发作后与复发间隔时间的危险因素。结果所有患者首次癎性发作后平均复发时间为(7.03±17.52)个月,其中性别、起病年龄、发作类型、睡眠发作、热惊厥史、癫癎家族史对首次癎性发作后复发间隔时间的影响无统计学意义(均P>0.05);而病因、部分性或全面性发作、全面性强直阵挛发作、继发性癫癎、神经系统体征、脑电图慢波、异常放电、影像学异常及首次发作后是否正规治疗对复发间隔时间的影响有统计学意义(均P<0.05)。结论有明确病因、脑电图有慢波、异常放电、影像学异常、有神经系统体征为影响首次癎性发作后复发间隔时间的危险因素。对这些患者最好在首次发作后正规服用抗癎药物。     

剥夺睡眠脑电图对儿童精神运动性癫痫的诊断价值及其影响因素

目的 研究剥夺睡眠脑电图(EEG)对儿童精神运动性癫痫的诊断价值及其影响因素.方法 对110例常规EEG检查阴性的精神运动性癫痫患儿进行剥夺睡眠EEG检查;比较剥夺睡眠EEG检查阳性与阴性患儿的有关临床资料;并对有关指标作多因素Logistic回归分析.结果 睡眠剥夺EEG检查阳性62例(56.4％)、阴性48例(43.6％).与睡眠剥夺EEG阴性组相比,阳性组有缺氧窒息史的比率显著增高,有发作诱因的比率和癫痫的发作频率明显降低,发作时间明显延长(P ＜0.05 ～0.01).多因素Logistic回归分析显示,发作诱因、发作频率和发作时间是影响睡眠剥夺EEG阳性率的相关因素(P ＜0.05～0.001).结论 剥夺睡眠EEG可提高儿童精神运动性癫痫的诊断率,癫痫的发作诱因、发作频率和发作时间均为影响其阳性率的因素.     

头皮脑电图在功能性大脑半球切除术中的应用价值

目的探讨头皮脑电图(EEG)在功能性大脑半球切除术中的应用价值。方法回顾性分析8例药物难治性癫痫行功能性大脑半球切除术的患者,分析病因与术后转归相关性,着重分析术前头皮EEG背景活动、间歇期放电、发作起始及术后EEG特征。结果 8例患者以获得性病因为主。术前头皮EEG背景活动多表现为慢波增多,患侧显著;发作间歇期双侧半球呈现多脑区放电特征;发作起始EEG改变多为弥漫性改变;术后复查EEG,1个月内以双侧放电居多,半年以上复查以患侧放电居多。结论头皮EEG作为一种简便易行的检查手段,在功能性大脑半球切除术术前评估、术后随访中起到重要作用。     

额叶癫痫患者手术后疗效及其影响因素的分析研究

目的探究额叶癫痫患者手术后长期发作结局和影响预后的预测因素,以指导评估治疗并给予临床参考。资料和方法回顾性分析2016年1月—2020年2月于兰州大学第二医院功能神经外科经多模态癫痫外科评估体系精准评估并行手术治疗的30例额叶癫痫患者的临床资料,其中男17例、女13例,癫痫发作起始年龄(16.30±10.65)岁,手术治疗时年龄(23.98±11.04)岁,癫痫发作病程(7.68±6.37)年。多模态癫痫外科评估体系包括Ⅰ期无创评估和Ⅱ期侵入性评估,收集的各研究变量用描述性统计分析,采用多因素Logistic回归分析评估各研究变量对癫痫手术预后的重要性,确定潜在的预后预测因素,以探究额叶癫痫患者手术后癫痫控制情况及可能影响癫痫预后的各变量对预后疗效的影响。结果纳入的30例额叶癫痫患者临床资料分析结果显示,手术预后良好(EngelⅠ级)率为70%,平均随访(29.9±14.1)个月,多因素Logistic回归分析结果显示,癫痫病程、癫痫发作频率、是否行立体定向脑电图(SEEG)监测、致痫病灶是否完全切除、是否出现术后急性期癫痫发作是影响预后的独立预测因素(P0.05)。结论癫痫病程长、发作频率频繁、出现术后急性期癫痫发作与不良预后显著相关,而SEEG的应用、致痫病灶的完全切除可显著改善手术预后。     

病毒性脑炎患儿恢复期癫痫的临床表现及高危因素分析

目的 探讨病毒性脑炎患儿恢复期SEP危险因素,并评估预后.方法 对133例病毒性脑炎出院患儿进行随访,恢复期SEP患儿21例作为试验组,比较2组患儿的临床表现、脑脊液、头颅影像学及脑电图特点,分析恢复期SEP高危因素.结果 试验组癫痫发作次数、惊厥持续时间、癫痫持续状态、脑脊液HSV-1 IgG检出率、EEG中重度异常及恢复时间均高于对照组,2组比较差异有统计学意义（P＜0.05或P＜0.01）.Logistic回归分析显示,癫痫发作次数、惊厥持续时间和EEG中重度异常及恢复时间为病毒性脑炎恢复期SEP的危险因素（P＜0.05）.结论 病毒性脑炎恢复期SEP的高危因素为急性期癫痫发作次数、惊厥持续时间和EEG中重度异常及恢复时间.     

癫癎患者药物规范化治疗预后的前瞻性研究

目的探讨抗癫癎药物规范化治疗2年以上癫癎患者的预后及影响预后的危险因素。方法根据临床病史及脑电图确诊为癫癎,按照发作类型规范化药物治疗、定期随诊2年以上,630例癫癎患者中符合研究条件者108例。比较基线期3个月与规范化治疗2年后3个月平均每月癫癎发作频率。分析起病年龄、性别、规范化治疗前病程、病因、发作类型、发作类型种数、脑电图有无癫痫波、单药或联合用药8种因素与预后的关系。结果单因素分析中性别、发病年龄、病因分型、有无癫癎波与预后差异无统计学意义;规范化治疗前病程、发作类型、发作类型种数、单药／联合用药的预后有显著性差异（P〈0．01）;规范治疗前病程与预后呈简单线性关系;多因素：二元Logistic回归进一步分析得出需多药治疗是预后不佳的重要预测因子。结论癫癎患者药物规范化治疗2年后有效率达到78．7％（P=0．001,OR=6．729）;越早规范化治疗预后越好;需多药治疗是预后不佳的重要预测因子。     

剥夺睡眠脑电图对儿童精神运动性癫痫的诊断价值及影响因素

目的探讨剥夺睡眠脑电图(EEG)在小儿精神运动性癫痫(psychomotor epilepsy,PE)中的临床应用价值及相关影响因素。方法 2012-01—2014-01选取行常规性EEG检查正常的158例PE患儿行剥夺性EEG检查,根据检查结果将PE患儿分为剥夺睡眠EEG阴性组102例以及阳性组56例,分析2组患儿临床资料,并采用Logistic多因素分析影响剥夺睡眠EEG诊断阳性率的相关影响因素。结果剥夺睡眠EEG阳性组癫痫发作频率及有发展诱因的比率低于阴性组,而缺氧窒息史比率高于阴性组,发作时间较长,差异有统计学意义(P0.05)。经Logistic多因素分析显示,发作时间、发作诱因、发作频率是影响剥夺睡眠EEG阳性率的独立危险因素。结论对PE患儿应用剥夺睡眠EEG诊断可提高阳性检查率,患儿癫痫发作时间、发作诱因及发作频率可影响剥夺睡眠EEG诊断阳性率。     

6例磁共振阴性额叶癫痫患者致痫灶定位研究

目的探讨硬膜下电极脑电图(ECo G)监测对磁共振阴性癫痫患者致痫灶的定位作用。方法对经临床、影像学和头皮EEG检查不能确定致痫灶部位的6例难治性额叶癫痫患者,植入硬膜下条状电极进行视频EEG监测,观察颅内电极发作期及发作间期EEG变化,结合头皮EEG、临床发作结果对癫痫灶进行综合定位;术后随访,评估致痫灶定位的准确性。结果 6例患者颅内电极埋藏时间为2~5 d,每例监测到2次临床发作并记录发作间期和发作期的异常放电活动。5例患者发作期颅内电极EEG均能准确定位,5例显示一侧局灶性放电起源,1例患者显示双侧放电起源。术后按Engel疗效分级:EngelⅠ级4例(57.1%),EngelⅡ级1例(14.3%),随访不满1年的按谭氏术后效果分级,达到了满意。结论颅内电极EEG监测可为癫痫手术治疗提供可靠的病灶定位依据。     

家庭因素对帕金森病患者预后的影响

目的 观察新诊断的帕金森病患者经治疗后1a的Hoehn-Yahr(修正)分级量表评分,探讨影响帕金森病患者预后的相关因素。方法 选择2014-11-01—2016-11-01在乐山市人民医院新诊断的105例帕金森病患者,对其进行大于1a的随访。详细记录患者的性别、年龄、文化程度、病程、发作类型、脑电图及头颅影像学检查结果、家庭因素。用Excel建立数据库,应用单变量分析和Logistic回归分析判断帕金森病患者预后的影响因素(P0.05)。结果 治疗1a后患者的缓解率为51%(1a后患者Hoehn-Yahr评分3分归入缓解组)。在单因素分析中,缓解组与未缓解组在年龄、病程、脑电图及头颅影像学检查结果、家庭因素方面差异有统计学意义(P0.05)。2组患者在发作类型、性别、文化程度方面的差异无统计学意义(P0.05)。根据单因素分析结果,对年龄、病程、脑电图及头颅影像学检查结果、家庭因素4个因素进行Logistic回归分析。结论 帕金森病患者的预后受临床及家庭关系的共同影响。除受年龄不可控影响,家庭关系极端型是帕金森病患者预后差的独立危险因素,应进一步加强干预。     

Focal features in patients with idiopathic generalized epilepsy

Purpose: The stringent dichotomy between focal and generalized epilepsies has become a contentious issue, since neuropathological studies as well as structural and functional imaging data hypothesized the existence of focal brain abnormalities in patients with well-documented idiopathic generalized epilepsy. The aim of our study was to investigate whether clinical and EEG features generally considered typical for a focal seizure disorder also occur in patients with generalized epilepsies to further support the hypothesis of a more continuous transition between focal and generalized epilepsies in contrast to the present concept of a stringent pathophysiologic dichotomy. Methods: We retrospectively studied 20 consecutive patients with idiopathic generalized epilepsy who underwent video EEG monitoring either because of uncertainty of their epilepsy syndrome or because of a difficult to treat epilepsy. We determined the incidence of (a) focal interictal epileptiform discharges (IEDs), (b) intermittent temporal slow waves, and (c) clinical signs that are widely accepted as typical for a focal seizure onset, i.e. version, tonic/dystonic unilateral posturing, postictal hemiparesis, postictal nose wiping and figure of 4. Results: Focal IEDs occurred in seven patients (35.0%), intermittent temporal slow waves in six (30%), and clinical signs pointing towards a focal seizure onset were found in seven patients (35%). Conclusion: Our study of EEG and clinical data supports the more sophisticated previous investigations in which structural and functional imaging as well as histopathological data suggested the presence of focal brain abnormalities in patients with ‘generalized’ epilepsies. Furthermore we emphasize the cautious use of isolated focal EEG abnormalities and certain clinical signs to prevent a premature diagnosis of focal epilepsy in patients who may indeed suffer from a generalized seizure disorder.     

EEG and clinical predictors of medically intractable childhood epilepsy.

OBJECTIVES: To identify electroencephalographic and clinical factors associated with both seizure control and medical intractability in children with epilepsy. METHODS: We retrospectively reviewed EEGs and medical records from children with well-controlled epilepsy or medically intractable epilepsy. SUBJECTS: Features of the initial EEG and clinical findings were compared in 39 children with well controlled seizures and 144 with intractable epilepsy using both univariate and multivariate analyses. RESULTS: Strong univariate associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, asymmetry, abnormal amplitude, a high frequency of spikes or sharp waves, and focal spike and wave activity. With multiple logistic regression, independent predictors of intractability were diffuse slowing and focal spike and wave activity. Strong univariate associates of clinical factors with intractability included: an early age of onset, simple partial, tonic, and myoclonic seizures, a history of status epilepticus, a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging of the head. Multivariate analysis detected 4 independent clinical features associated with intractable epilepsy: symptomatic etiology, tonic seizures, simple partial seizures, and an early age of onset. CONCLUSIONS: There are a number of EEG and clinical features that can be identified early in the course of childhood epilepsy that are predictive of outcome. These findings will need to be verified in a prospective study.     

Landau–Kleffner syndrome: A study of 29 patients

PurposeThe aim of the study was to retrospectively analyze the electroclinical features, etiology, treatment, and prognosis of 29 patients with Landau–Kleffner syndrome (LKS) with a long-term follow-up.MethodsInclusion criteria were a diagnosis of LKS with: (1) acquired aphasia or verbal auditory aphasia; (2) with or without focal seizures, secondarily generalized tonic-clonic seizures, absences, or atonic seizures.ResultsMean follow-up was 12 years. All cases except six had seizures. Before the onset of aphasia, developmental language and behavioral disturbances were present in 19 and 14 patients, respectively. All patients had verbal auditory agnosia. Aphasia was severe in 24 patients and moderate in five. Nonlinguistic cognitive dysfunctions were moderate in 14 patients. Behavioral disturbances were found in 16 patients. During the continuous spike-and-wave discharges during slow sleep phase, the spike-wave index was >85% in 15, 50–85% in eight, and 30–50% in four. In two patients, the EEG recording showed occasional bilateral spikes, without continuous spike-and-wave discharges during slow sleep. In this phase, the awake EEG recording showed more frequent interictal abnormalities, predominantly in the temporal regions. Eight patients recovered language completely, but the remaining patients continue to have language deficits of different degrees.ConclusionLandau–Kleffner syndrome is an epileptic encephalopathy characterized by acquired verbal auditory aphasia and seizures in most of the patients associated with continuous or almost continuous spike-and-wave discharges during slow wave sleep. The most commonly used treatments were clobazam, ethosuximide, sulthiame. High-dose steroids were also administered. Adequate and early management may avoid language and cognitive deterioration.     

Electroencephalographic findings in severe symptomatic partial epilepsies in childhood

The EEG records of 64 patients affected by a symptomatic severe partial epilepsy have been reviewed retrospectively. The epilepsy started before age 12. The follow-up was at least 5 years after the onset of the disease. In a longitudinal study of interictal EEG, the following parameters were studied: normal or slightly abnormal EEG records at the onset, late appearance of abnormalities of background, multifocal abnormalities and generalized spike and wave discharges. The study of ictal EEG was performed in 32 patients: a good correlation with the interictal and ictal site of the discharges was found. The EEG semeiology of the seizures persisted unchanged throughout the evolution.     

Focal EEG abnormalities might reflect neuropathological characteristics of pervasive developmental disorder and attention-deficit/hyperactivity disorder

Neurophysiological characteristics in electroencephalograms (EEG) were investigated for patients with pervasive developmental disorder (PDD) and for patients with attention-deficit/hyperactivity disorder (AD/HD). This study examined 64 PDD children and 22 AD/HD children with no history of epilepsy or progressive neurological or psychiatric disorder. We used multivariate analysis to compare EEG abnormalities, clinical symptoms, and intelligence levels between PDD and AD/AD patient groups. Paroxysmal discharges at the frontopolar-frontal (Fp-F) brain regions and background EEG abnormalities tended to be detected preferentially in the PDD group, although paroxysmal discharges at central-temporal (C-T) regions tended to be detected preferentially in the AD/HD group. The paroxysmal discharges observed in patients expressing persistence and impulsivity are apparently localized respectively in the Fp-F and C-T regions. A combination of EEG abnormalities, including background EEG abnormalities and paroxysmal discharges at Fp-F and C-T regions, might be useful diagnostic hallmarks to distinguish PDD with AD/HD from AD/HD alone using a logistic regression model. The dysfunction of specific brain areas associated with EEG abnormalities might explain characteristics of clinical symptoms observed in PDD and AD/HD patients.     

脑电图对小儿病毒性脑炎诊断和转归的评价

目的探讨病毒性脑炎儿童脑电图异常与病情及预后关系。方法对96例病毒性脑炎的脑电图结果进行回顾性分析。结果脑电图异常率为94.8%。轻型、普通型多表现为弥漫性中波幅或高波幅慢波改变,预后好。重症组以局限性、低波幅慢波多见,预后差。脑电图出现癫样放电者,应警惕继发癫的可能。结论脑电图对小儿病毒性脑炎诊断和转归评估中有较高的价值。     

Long-term significance of postictal psychotic episodes: II. Are they predictive of interictal psychotic episodes?

OBJECTIVE: The aim of this study was to determine whether postictal psychotic episodes (PIPE) are predictive of the development of interictal psychotic episodes (IPE). METHODS: This was a retrospective study of 18 consecutive adults with a partial seizure disorder and PIPE (study group) and 36 patients with a partial seizure disorder but without PIPE (control group). These two groups were compared with respect to the likelihood of developing IPE over an 8-year follow-up period and the variables operant in the development of IPE. Statistical analyses consisted of logistic regression models to identify the variables predictive of the development of IPE. Predictors included: number and location of ictal foci, seizure type, etiology, age at seizure onset, duration of seizure disorder, MRI abnormalities, and psychiatric history prior to the index video/EEG monitoring (other than PIPE). RESULTS: Seven patients with PIPE and one control patient went on to develop an IPE. Predictors of IPE in univariate logistic regression analyses included a history of PIPE (P=0.006), male gender (P=0.028), and having bilateral ictal foci (P=0.048). Significance disappeared for all of these variables when they were entered into a multivariate analysis. CONCLUSIONS: A history of PIPE may be a risk factor for the development of IPE. Yet, the disappearance of significance on multivariate analysis indicates that it is not an independent predictor.     

A novel nomogram for early prediction of death in severe neurological disease patients with electroencephalographic periodic discharges

ObjectiveTo investigate death-related factors in patients with electroencephalographic (EEG) periodic discharges (PDs) and to construct a model for death prediction.MethodsThis case-control study enrolled a total of 80 severe neurological disease patients with EEG PDs within 72 h of admission to the neuroscience intensive care unit (NICU). According to modified Rankin scale (mRS) scores half a year after discharge, patients were divided into a survival group (<6 points) and a death group (6 points). Their relevant clinical and biochemical indicators as well as EEG characteristics were retrospectively analyzed. Logistic regression analysis was used to identify the risk factors associated with the death of patients with EEG PDs. A death risk prediction model and an individualized nomogram prediction model were constructed, and the prediction performance and concordance of the models were evaluated.ResultsMultivariate logistic regression analysis showed that the involvement of both gray and white matter in imaging, disappearance of EEG reactivity, occurrence of stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs), and an interval time of 0.5–4 s were independent risk factors for death. A regression model was established according to the multivariate logistic regression analysis, and the area under the curve of this model was 0.9135. The accuracy of the model was 87.01%, the sensitivity was 87.17%, and the specificity was 89.17%. A nomogram model was constructed, and a concordance index of 0.914 was obtained after internal validation.ConclusionThe regression model based on risk factors has high accuracy in predicting the risk of death of patients with EEG PDs.SignificanceThis model can help clinicians in the early assessment of the prognosis of severe neurological disease patients with EEG PDs.     

Electrophysiological characterization of spontaneous and carbamazepine-induced epileptic negative myoclonus in benign childhood epilepsy with centro-temporal spikes.

OBJECTIVE: Epileptic negative myoclonus (ENM), a transient muscular atonic phenomenon time-locked to epileptiform EEG abnormalities, is often observed in children with benign childhood epilepsy with centro-temporal spikes (BECTS). In some, for unknown reasons, ENM can be worsened by carbamazepine (CBZ). We describe two children aged 11 and 15 years, in whom CBZ precipitated seizure worsening and ENM. We investigated the morphological and topographic features of the EEG abnormalities while on CBZ and after CBZ withdrawal and compared them with those from 9 children with classical BECTS. The aim of the study was to identify possible electrophysiological specificities in patients who eventually develop ENM during CBZ treatment. METHODS: The characterization of EEG abnormalities, related (R) and unrelated to ENM (U), in patients with ENM and rolandic discharges (RD) and in matched controls with BECTS was performed based on polygraphic digital EEG recordings. Off-line time-domain analysis included correlation coefficient between EEG and EMG channels, quantitative analysis on ENM, and topographic analysis on spike-and-wave complexes. Z-score test and paired t test were used when appropriate for statistical analysis on R, U and RD. RESULTS: Recordings in both children with BECTS and ENM while on CBZ showed frequent R discharges (mean interval between R=19.89+/-9.4 s in patient 1; 2.16+/-1.2 s in patient 2). Withdrawal of CBZ produced abatement of R (no R recorded in patient 1; 5.69+/-7.1 s in patient 2) and reduction of the slow wave component of R (P<0.01). Morphology and topography of R and RD differed in field distribution, amplitude (P<0.01) and duration (P<0.01) of the slow wave component. RD and U did not show a significantly different morphology and field distribution. CONCLUSIONS: Our findings suggest that an increased cortical inhibition could be the electrophysiological correlate of CBZ-induced ENM. If confirmed on a larger series, the presence of spike-wave (rather than sharp waves) discharges in children with BECTS might be used as an electrophysiological predictor of an abnormal response to CBZ.