病毒性脑炎后癫痫的预后及其影响因素

目的探讨病毒性脑炎后癫痫(PEE)的预后及其影响因素。方法对50例病毒性脑炎伴PEE患者进行随访,以从未达到1年无发作为预后差评价指标,观察其预后。收集患者的临床资料,分析影响PEE预后差的危险因素。结果预后差组患者脑炎急性期有意识障碍及脑炎急性期有痫性发作、发作次数10次的比率显著高于预后好组(均P0.01)。年龄、性别、发作类型、脑炎急性期精神障碍、脑炎急性期神经系统缺损、脑炎急性期SE、CSF细胞数增多、EEG异常、头颅CT/MRI异常与预后差无相关性(均P0.05)。多因素Logistic回归分析显示,脑炎急性期意识障碍、脑炎急性期发作是PEE患者预后差的独立危险因素(OR=7.269,95%CI:1.22~43.35,P=0.029;OR=22.893,95%CI:4.02~130.43,P=0.000)。结论脑炎急性期意识障碍、脑炎急性期痫性发作是影响PEE预后差的独立危险因素。     

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.     

病毒性脑炎急性期继发癫痫的临床特点

目的:分析病毒性脑炎急性期继发癫痫的临床特点。方法:1982年4月5日～2003年12月15日连续住院的374例病毒性脑炎患者,采用统一的调查表,用Microsoft Access 2002建立数据库,共51个主项内容,部分主项有下属分项。分析患者癫痫发病情况,对比观察继发癫痫患者和无癫痫发作患者脑电图结果及预后情况。结果:374例中115例(30.8％)继发癫痫,其中全面发作72例(62.6％),单纯部分发作18例,复杂部分发作11例,部分继发全面14例。115例患者中23例(20.0％)出现癫痫持续状态,14例(12.2％)继发多系统损害,普通脑电图检查20例发现痫性放电,占17.4％。继发癫痫组额叶、颞叶损害共54例,占47.0％。继发癫痫组与无癫痫发作组比较,脑电图异常程度差异有显著意义(x2=23.6,P<0.01),大脑皮质损害发生率差异有显著意义(x2=85.53,P<0.001)。继发癫痫组住院天数26.1±23.6,无癫痫发作组住院天数17.9±5.0,二者比较差异有显著意义(t=5.33,P<0.001)。结论:急性病毒性脑炎后继发癫痫发作以全面发作最为常见,大脑皮质损害易于继发癫痫,癫痫发作影响病毒性脑炎患者病情恢复。     

脑炎后癫痫发作相关因素分析

目的 对影响脑炎后癫痫(PEE)发作及难治性PEE的相关因素进行回顾性分析.方法 对1995年1月至2010年12月在我院住院及门诊诊断的237例病毒性脑炎患者进行回顾性研究.以PEE及难治性癫痫为评价指标.分析因素包括:年龄、性别、癫痫发作类型、首次发作出现的时间、间隙期脑电图、神经影像资料、早期激素治疗等.结果 237例患者纳入本研究,平均年龄26.3(15～57)岁,103例患者出现PEE(43.46％),其中67例为部分性发作.PEE出现的相关危险因素:年龄(OR=3.72,95％ CI 2.70 ～ 5.25,P=0.018)、意识障碍(OR=5.37,95％ CI 2.43 ～ 13.03,P=0.012)、皮质受损(OR=11.42,95％ CI 5.94 ～ 31.27,P=0.000)、间隙期脑电图癫痫样放电(0R=18.04,95％CI 7.30～48.38,P=0.000)和急性期抽搐发作(OR=32.68,95％ CI 9.62～97.59,P=0.000)等.难治性癫痫61例,发生的相关因素:部分性发作(OR =4.09,95％ CI 2.14～9.10,P=0.021)、急性期癫痫持续状态(OR=4.48,95％ CI l.89 ～8.07,P=0.017)、间隙期脑电图多灶性棘慢波(0R=5.53,95％ CI 2.91 ～ 10.07,P=0.006)、皮质受损(OR=2.33,95％ CI l.37～7.72,P=0.028)和急性期难以控制的发作(OR =6.17,95％ CI 3.52 ～ 11.34,P=0.001).而早期激素治疗(OR =2.19,95％CI l.11～4.87,P=0.037)和首次发作出现的时间延迟(OR=4.40,95％ CI 3.19～11.62,P=0.014)可以减少难治性癫痫的出现风险.结论 PEE是脑炎后患者常见的并发症,特别是难治性癫痫尤为多见,有多重因素与其具有相关性.     

视频脑电图结合磁共振扫描对颞叶癫痫术前定位的探讨

目的 探讨视频脑电图及磁共振扫描对颢叶癫痫术前定位的准确性.方法 回顾分析146例颞叶癫痫病例,术前均行长程视频脑电图(V/EEG)监测及磁共振扫描(MRI),发作时V/EEG所示的痫样放电部位与MRI检查所发现的病变同侧时,将此侧颞叶作为癫痫灶颞叶;MRI未见异常,则根据三次以上发作时V/EEG定侧.所有患者经术中皮层脑电图和深部脑电监测后,行前颞叶切除术.结果 术中皮层脑电图及深部脑电监测均发现有痫样放电,与术前V/EEG监测吻合.术后102例(70%)癫痫发作完全消失,显著改善35例(24%),良好6例(4%),无改善3例(2%).结论 V/EEG结合MRI对颞叶癫痫术前能进行准确定位.     

探讨儿童部分性癫痫发作发作间期脑电图及与影像学的关系

目的探讨儿童部分性癫痫发作发作间期EEG及与影像学的关系。方法对67例部分性发作的癫痫患儿行长程录像脑电监测(VEEG)及影像学检查,分析发作间期EEG及与影像学的关系。结果与发作间期EEG正常的患儿比较,EEG异常患儿影像学正常率显著降低,影像学异常率显著增高(χ2=5.154,P=0.023)。发作间期异常放电51例患者中,42例(82.4%)间期放电与发作期部位一致,其中20例(47.6%)影像学检查正常,22例(52.4%)影像学检查异常,两者相比差异无统计学意义(P=0.726)。结论发作间期EEG异常部分性癫痫患儿,影像异常率高,大多数患儿发作间期放电与发作期起始放电部位一致。     

动态脑电图在癫痫与发作性疾病的诊断及鉴别诊断上的意义

目的　探讨动态脑电图(AEEG)对癫痫及发作性疾病的诊断及鉴别诊断的意义。方法　272例患者使用常规脑电图( EEG)与 AEEG 检查,并作比较。结果　272 例中 EEG 异常 105 例(38.60%),其中痫样放电 48 例( 17. 65%); AEEG 异常 174 例( 63. 97%),其中痫样放电 113 例(41.54%)。113例AEEG痫样放电中癫痫组87例,发作性疾病组 26 例,经χ2 检验均有非常显著差异(P <0.000 1)。结论　AEEG可提高痫样放电的检出率,在癫痫、发作性疾病的诊断、鉴别诊断上具有重要意义。     

脑炎后癫痫诊断与治疗进展

脑炎后癫痫(Postencephalitic epilepsy,PEE)是指脑炎急性期后出现癫痫发作,是急性脑炎常见的后遗症,部分可发展为难治性癫痫。病毒感染引起的PEE是最常见类型。文章总结了PEE的病因、流行病学、发病机制,PEE发生相关的危险因素以及用药指征,以期为该疾病的诊断、治疗及预后评估提供临床参考。     

急性期病毒性脑炎患儿临床特点及对继发癫痫的影响

目的探讨急性期病毒性脑炎(VE)患儿临床特点,并分析影响继发癫痫(SEP)的相关因素。方法收集2014-06—2017-06就诊于郑州大学附属儿童医院的76例急性期VE患儿的临床资料,对患儿临床特点进行统计分析,采用Logistic回归模型分析影响急性期VE后SEP的危险因素。结果76例患儿中21例出现SEP,发生率为27.6%。单因素分析显示,VE后SEP组急性发作时出现癫痫持续状态、发作次数>10次的比例均明显高于非SEP组(P<0.05),急性期后继续服用抗癫痫药物(AEDs)比例明显低于非SEP组(P<0.05)。多因素Logistic回归分析显示,急性期出现癫痫持续状态(OR=1.570)、发作次数>10次(OR=1.988)是VE后发生SEP的危险因素(P<0.05),急性期后使用AEDs(OR=0.725)是VE后发生SEP的保护因素(P<0.05)。结论VE患儿SEP发生率较高,癫痫持续状态、发作次数>10次是SEP发生的独立危险因素,建议急性期继续予以AEDs以预防SEP发生。     

颅脑手术前后继发性癫痫的动态脑电图监测

目的 了解颅脑手术前后继发性癫痫的动态脑电图表现特点及其与手术的关系。方法 选择290例颅内占位性疾病患者,术前1～3d及术后1周、1～3月分别观察其EEG表现。结果 术前有癫痫发作(A组)128例,EEG示痫样放电者117例,痫波检出率为91.4％。术后97例无临床发作,有效率为75.8％;术前无癫痫发作(B组)162例,EEG可见痫样放电者24例。术后新发癫痫19例,均可见痫样放电。结论 开颅手术是治疗继发性癫痫的有效手段,但也可能是导致继发性癫痫的原因之一。     

结节性硬化症患儿癫痫预后的危险因素分析

目的探讨影响结节性硬化症(TSC)患儿进展为难治性癫痫的危险因素。方法根据近1年内有无癫痫发作及药物控制情况,将83例合并癫痫的TSC患儿分为难治性癫痫组和癫痫控制组,比较两组患儿的临床资料、脑电图(EEG)和头颅MRI检查差异,并通过多因素Logistics回归分析确定影响难治性癫痫进展的独立危险因素。结果与癫痫控制组患儿相比,难治性癫痫组患儿中,癫痫首次发作年龄<2岁、新生儿癫痫、智商评分<70、婴儿痉挛史、合并林-戈综合征、自闭症、癫痫持续状态、使用抗癫痫药物≥3种的患儿显著升高。而难治性癫痫组患儿的EEG呈全面型的患儿比例显著高于癫痫控制组,磁共振(MRI)显示皮质结节≥3个的患儿比例也显著高于癫痫控制组(P<0.001)。多因素Logistics回归分析显示癫痫首次发作年龄<2岁(OR=1.243,95%CI:1.114~1.672,P=0.036)、合并自闭症(OR=3.892,95%CI:1.241~9.351,P=0.008)和大脑皮质结节≥3个(OR=1.905,95%CI:1.101~3.288,P=0.021)是影响难治性癫痫的独立危险因素。结论癫痫首发年龄小于2岁、合并自闭症和脑皮质结节数目超过3个是影响TSC患儿难治性癫痫进展的独立危险因素,对于此类TSC患儿应早期采取干预措施以预防或延缓难治性癫痫的进展。     

Epileptic seizures in subcortical vascular encephalopathy

Cerebrovascular disease is one of the most common causes of epilepsy in the elderly. Most of the studies published relate to cortical infarction, subarachnoid, and intracranial hemorrhage, whereas the incidence of epilepsy from subcortical ischemia, i.e. deep lacunar infarctions and diffuse white matter lesions, is obscure. Therefore, we prospectively examined 18 patients with the precisely defined diagnosis of subcortical vascular encephalopathy (SVE), who were admitted to our hospital due to epileptic seizures (group A), and compared them to a similarly selected group matched for age, sex, risk factors, and neurological deficits with an equivalent severity of SVE but without seizures (group B). Subcortical lacunar infarctions were significantly more frequent in group A than group B (15/18 versus 4/18, p < 0.001), whereas neither the extension, degree, distribution of periventricular white matter changes, nor the presence of internal hydrocephalus, focal or diffuse cortical atrophy showed any statistical significance. However, a temporal constant theta or delta EEG focus was present in 10/18 patients in group A but only in 1/18 patients from group B (p 0.005). 10/18 patients developed epilepsy with further seizures during follow-up. The association of SVE, multiple subcortical lacunas, and temporal EEG abnormalities are suggestive for an increased risk for epileptic seizures, which is particularly important for the treatment of patients with SVE if uncertain paroxysmal episodes occur, e.g. transient ischemic attacks, seizures, or cardiac syncope.     

Clinical evaluation of the patients with epilepsy following febrile convulsions

We studied clinical, EEG and developmental features of 46 epileptic children following febrile convulsions. Incidence of developing epilepsy was 9.9 percent. Eleven patients (group G) out of 46 had generalized epileptic seizures, and 34 patients (group P) had partial seizures. Febrile convulsions of early onset, partial seizures and postictal neurological symptoms were more striking in group P (p less than 0.05), whereas febrile convulsions of late onset and prolonged seizures were slightly dominant in group G. And EEG abnormalities were more frequent in group P (p less than 0.05). Group P patients had significant number of risk factors (complex features of febrile convulsions) than group G patients (p less than 0.01). The interval between the last febrile convulsion and subsequent epileptic seizures was shorter in group G (p less than 0.01). Although subsequent epileptic seizures were well controlled in the both groups (91% in group G and 82% in group P), intractable seizures were recognized in 9% of group P patients. The patients who had risk factors of prolonged seizures, postictal neurological symptoms and early onset manifested poor controlled epileptic seizures (p less than 0.01). Motor or mental deficits were more frequently associated with group P: in some patients they had been observed before the onset of febrile convulsions. These results suggest that pathogenesis of epilepsy following febrile convulsions may be different among various seizure types of subsequent epilepsy. And the risk factors during febrile convulsions may be related to the prognosis of subsequent epileptic seizures as well as the incidence of developing epilepsy.     

痫性放电实现异体间转道并致痫动物的研究报道

目的观察青霉素癫痫模型痫性放电能否被引导电极转道至异体大鼠脑内并致痫。方法实验大鼠海马局部注射青霉素建立癫痫模型,通过引导电极拟将痫性放电导入异体大鼠同侧海马,观察实验大鼠的行为学、脑电图变化。结果致痫组、痫能导出组12只大鼠全部点燃,痫能导入组6只大鼠亦出现痫性发作,痫能导出组痫性发作时程缩短,致痫组、痫能导出组、痫能导入组大鼠脑电图均可记录到痫性波;对照组、电极组无痫性发作。结论实验性痫性放电可通过引导电极在异体大鼠脑组织间传导,脑内痫性放电有可能被电极导出。     

病毒性脑炎急性期继发性全身性强直-阵挛发作的危险因素分析

目的探讨病毒性脑炎急性期继发性全身性强直-阵挛发作的危险因素。方法资料完整的急性病毒性脑炎患者374例,其中,病例组继发性全身性强直-阵挛发作组72例,对照组(无抽搐发作组)259例,系同期住院患者;病例组和对照组采用统一的调查表,用MicrosoftAccess2002建立数据库,共52个主项内容,部分主项有下属分项;对研究资料先进行单因素分析,然后进行多因素非条件Logistic回归模型分析。结果经分析筛选出大脑皮质损害、多灶性损害、脑电图异常、昏迷、颅内压升高等5个因素为脑炎后继发癫痫间的独立危险因素。结论病毒性脑炎后急性期强直-阵挛发作的发生主要与大脑皮质损害关系密切,昏迷、颅内压升高可促发脑炎后强直-阵挛发作。     

Status epilepticus revealing syphilitic meningoencephalitis

The incidence of seizures in neurosyphilis ranges from 14 to 60%, however, neurosyphillis presenting with status epilepticus (SE) is rare. We report the case of a 49 year old man with no history of epilepsy and with a 9-year history of untreated syphilitic chancre. He presented in October 2005 with four stereotyped epileptic seizures lasting less than 2 minutes followed by a prolonged seizure lasting 20 minutes without recovery of consciousness. He regained consciousness after admission in intensive care unit for SE management. Brain CT scan showed disappearance of cortical sulci with collapse of ventricles. Ophthalmological examination revealed papillary hyperemia. Interictal EEG showed bi-frontal bi- and triphasic spikes. Syphilitic serology in blood then in cerebrospinal fluid (CSF) confirmed the diagnosis of neurosyphilis. The clinical course was favorable after early administration of penicillin and carbamazepine with total remission of seizures. We underline the rarity of neurosyphilis vasculitis as possible etiology of SE and underline the crucial value of syphilitic serology in blood then in CSF, especially within any atypical presentation of encephalitis, meningoencephalitis; or encephalitis and vasculitis. We highlight the very good prognosis if treated precociously.     

Autism and epilepsy: a retrospective follow-up study

So-called "idiopathic" autism, which exhibited no major complications before diagnosis is well-known as one of the risk factors for epilepsy. This retrospective follow-up study aimed to clarify the characteristics of epilepsy in the autism; onset of seizure, seizure types, EEG findings and epilepsy outcome and the differences as a group between the autism with epilepsy and those without epilepsy. One hundred thirty individuals with autistic disorder or atypical autism diagnosed in childhood were followed up over 10 years and were evaluated almost every year up to 18-35 years of age. Their medical records related to perinatal conditions, IQ, social maturity scores and several factors of epilepsy were reviewed in October 2005. Thirty-three of the follow-up group (25%) exhibited epileptic seizures. The onset of epilepsy was distributed from 8 to 26 years of age. Two types of seizure were observed; partial seizure with secondarily generalized seizure and generalized seizure. Twenty of the epileptics (61%) showed the partial seizure. Although 18% of the non-epileptic group exhibited epileptic discharges on EEG, 68% of the epileptic group revealed epileptiform EEG findings before the onset of epilepsy. No differences were observed concerning the sex ratio, autistic disorder/atypical autism and past history of febrile seizures between the epileptic and non-epileptic groups. Lower IQ, lower social maturity score and higher frequency of prescribed psychotropics were observed in the epileptic group compared to the non-epileptics. Idiopathic autism was confirmed as the high risk factor for epilepsy. Epileptiform EEG findings predict subsequent onset of epileptic seizures in adolescence. Epilepsy is one of negative factors on cognitive, adaptive and behavioral/emotional outcomes for individuals with autism.     

Multi-scale phase average waveform of electroencephalogram signals in childhood absence epilepsy using wavelet transformation

BACKGROUND: Recent studies have focused on various methods of wavelet transformation for electroencephalogram (EEG) signals. However, there are very few studies reporting characteristics of multi-scale phase waves during epileptic discharge.OBJECTIVE: To extract multi-scale phase average waveforms from childhood absence epilepsy EEG signals between time and frequency domains using wavelet transformation, and to compare EEG signals of absence seizure with pre-epileptic seizure and normal children, and to quantify multi-scale phase average waveforms from childhood absence epilepsy EEG signals. DESIGN, TIME AND SETTING: The case-comparative experiment was performed at the Department of Neuroelectrophysiology, Tianjin Medical University from August 2002 to May 2005. PARTICIPANTS: A total of 15 patients with childhood absence epilepsy from the General Hospital of Tianjin Medical University were enrolled in the study. The patients were not administered anti-epileptic drugs or sedatives prior to EEG testing. In addition, 12 healthy, age- and gender-matched children were also enrolled.METHODS: EEG signals were tested on 15 patients with childhood absence epilepsy and 12 normal children. Epileptic discharge signals during clinical and subclinical seizures were collected 10 and 20 times, respectively. The collected EEG signals were treated with wavelet transformation to extract multi-scale characteristics during absence epilepsy seizure using a conditional sampling method. Multi-scale phase average waveforms were collected using a conditional phase averaging technique. Amplitude of phase average waveform from EEG signals of epilepsy seizure, subclinical epileptic discharge, and EEG signals of normal children were compared and statistically analyzed in the first half-cycle.MAIN OUTCOME MEASURES: Multi-scale wavelet coefficient and the evolution of EEG signals were observed during childhood absence epilepsy seizures using wavelet transformation. Multi-scale phase average waveforms from EEG signals were observed using a conditional sampling method and phase averaging technique.RESULTS: Multi-scale characteristics of EEG signals demonstrated that 12-scale (3 Hz) rhythmical activity was significantly enhanced during childhood absence epilepsy seizure and co-existed with background structure (＜1 Hz, low frequency discharge). The phase average wave exhibited opposed phase abnormal rhythm at 3 Hz. Prior to childhood absence epilepsy seizure, EEG detected opposed abnormal a rhythm and 3 Hz composition, which were not detected with traditional EEG. Compared to EEG signals from normal children, epileptic discharges from clinical and subclinical childhood absence epilepsy seizures were positive and amplitude was significantly greater (P＜0.05).CONCLUSION: Wavelet transformation was used to analyze EEG signals from childhood absence epilepsy to obtain multi-scale quantitative characteristics and phase average waveforms. Multi-scale wavelet coefficients of EEG signals correlated with childhood absence epilepsy seizure, and multi-scale waveforms prior to epilepsy seizure were similar to characteristics during the onset period. Compared to normal children, EEG signals during epilepsy seizure exhibited an opposed phase model.