儿童良性枕叶癫痫47例临床及脑电图分析

目的：探讨儿童良性枕叶癫痫（BECOP）的临床表现及脑电图（EEG）特点,以期提高对此病的认识水平。方法：对2005年1月至2010年12月南京军区福州总医院癫痫中心收治的47例BE—COP患儿资料进行回顾性分析,将其分为早发性儿童良性枕叶癫痫（EBOS）组和晚发性儿童良性枕叶癫痫（LOS）组,对比研究两组的起病年龄、发作频率、持续时间及发作时间分布、临床特征、EEG改变及对药物治疗的反应。结果：EBOS组平均起病年龄为（5．2±2．8）岁,以自主神经症状发作为主,发作频率低而持续时间长,有夜间发作倾向;LOS组平均起病年龄为（10．3±3．2）岁,发作频率高而持续时间短,视觉症状常见,可出现视幻觉,易继发全身性强直阵挛发作,以白天发作为主。两组患儿头眼偏转发作、跌倒发作及发作后头痛、呕吐症状比较差异无显著意义。两组发作间期EEG大部分显示枕区为主的棘、尖慢波,但EBOS组较局限且波形典型,LSO组易于泛化。发作期显示枕区或额区为主或全脑节律性棘慢波活动。EBOS对抗癫痫药物反应好,单药治疗23例（92％）可完全控制发作;LOS对抗癫痫药物治疗反应稍差,14例（63．6％）可控制发作,5例好转,3例无效。结论：EBOS和LOS在起病年龄、发作频率及持续时间、发作时间分布、自主神经系统症状、视觉症状、EEG放电特点、抗癫痫药物治疗反应等方面均有差别,综合分析可作出鉴别诊断。     

癫痫发作期心脏自主神经功能的研究

目的通过视频脑电-心电监测,研究部分性癫痫发作期心率变化,探讨不同部位起源、不同发作形式以及睡眠与觉醒对心率变化的影响,总结并分析癫痫发作前后心率演变规律。方法回顾性分析2011-2013年81例癫痫患者181次发作的视频脑电-心电监测资料,将癫痫发作期心率变化幅度分成5种类型,绘制心率变化曲线图,并从发作部位（额、颞、枕）、发作形式（SPS、CPS和CPS．G）、睡眠与觉醒等方面分析癫痫发作对心率变化的影响。结果181次发作心率差值（53．2±26．7）次/min,额、颞、枕心率差值分别为（53．3±28．5）次／min、（53．2±24．1）次／min和（52．8±31．9）次／min;睡眠期（72次）和清醒期（109次）发作心率差值分别为（62．8±25．4）次／min和（46．8±25．7）次,min;SPS、CPS和CPS-G发作心率差值分别为（32．8±24．4）次/min、（47．7±20．6）次／min和（79．3±22．4）次／min。结论发作类型为CPS．G、睡眠期、右侧起源、男性、年龄大于14岁的患者心率变化显著,癫痫发作期的心率随时间变化有一定的演变规律。     

Video-EEG在小儿发作性疾病中诊断价值的探讨

目的：评价Video-EEG（Video-脑电图）在鉴别诊断小儿发作性疾病中的应用价值,以及对癫痫分类的指导意义。方法：对拟诊为癫痫性发作（ES）的274例患儿和拟诊为非癫痫性发作（NES）的396例患儿,进行1-6h的Video-EEG动态监测。监测包括清醒-睡眠周期,并利用各种诱发试验;监测中和结束后对记录的Video-EEG进行分析,并与原拟的诊断作回顾性对比。结果：①274例临床上拟诊为ES的患儿,平均记录时间5．1h,125例（45．6％,125／274）监测到发作,其中112例（89．6％,112／125）为ES,91例（81.3％,91／112）确定了发作类型,42例（37．5％,42／112）发作类型得到修正;8例（6.4％,8／125）为NES;5例（4％,5／125）为癫痫合并NES。149例（54．4％,149／274）未监测到临床发作,其中78例记录到癫痫样放电;②临床上拟诊为NES的396例患儿平均记录时间2．4h,307例（77.5％,307／396）监测到发作,其中283例（92.2％,283／307）证实为NES,24例（7．8％,24／307）为ES。89例（22．5％,89／396）未监测到发作,其中2例（2．2％,2／89）记录到癫痫样放电。结论：Video-EEG是鉴别诊断ES和NES及明确ES分类的可靠检查方法。     

Sensitivity of a Seizure Activity Detection Computer in Childhood Video/Electroencephalographic Monitoring

Summary: Purpose : Few data describe the sensitivity of a "Seizure Activity Detection Computer" (SzAC) in childhood video/EEG (VEEG) monitoring, especially for very young children. We examined the accuracy of SzAC in childhood VEEG monitoring in different pediatric age groups.
Methods : We visually analyzed VEEG monitoring samples for randomly designated subsets of 56 patients with childhood epilepsy, reviewing 335 visually detected electrographic seizures to analyze the sensitivity of SzAC for each age group as well as the electrographic characteristics affecting the sensitivity of automated computer-based seizure detection.
Results : SzAC was positive in 227 of 335 (67.8%) visually identified electrographic seizures in the entire study group. The SzAC sensitivity for infants (age 2 months to 2 years) was 59.7% (43 of 72 seizures); for young children (age 3–10 years), sensitivity 56.5% (91 of 161 seizures). In adolescents (age 11–18 years), SzAC was positive in 93 of 102 (91.2%) seizures- i.e., in a significantly greater number of seizures than in younger age groups. SzAC was significantly less sensitive in detecting electrographic seizures characterized as being of short duration or of low voltage.
Conclusions : The overall sensitivity of SzAC in detecting childhood electrographic seizures was 67.8%. The sensitivity was significantly less in younger age groups as compared with that in children aged >11 years. Electrographic seizures of relatively short duration or low voltage were often missed by SzAC.     

Development,evaluation and implementation of video-EEG telemetry at home

PurposeTo describe the development and implementation of video EEG telemetry (VT) in the patient's home (home video telemetry, HVT) in a single centre.MethodsHVT met the UK Medical Research Council definition of a complex intervention, and we used its guidance to evaluate the process of piloting, evaluating, developing and implementing this new clinical service. The first phase was a feasibility study, comparing inpatient VT (IVT) with HVT in a test–retest design (n = 5), to assess data quality and yield of clinically relevant events. The second phase was a pre-implementation study (n = 8), to examine acceptability and satisfaction as well as the costs of IVT and HVT. Subsequently, we implemented the service, and reviewed the outcomes of the first 34 patients.ResultsThe feasibility study found no difference in the quality of recording or clinical yield between IVT and HVT. The pre-implementation study showed excellent patient satisfaction. We also discuss the findings of the main stakeholder survey (consultants and technicians). Our economic modelling demonstrates a clear financial superiority of HVT over IVT.ConclusionOur findings show that diagnostic HVT for seizure classification and polysomnographies can be carried out safely in the patients’ home and poses no security risks for staff. HVT can be effectively integrated into an existing tertiary care service as a routine home or community-based procedure. We hope to encourage other clinical neurophysiology departments and epilepsy centres to take advantage of our experience and consider adopting and implementing HVT, with the aim of a nationwide coverage.     

额叶癫痫的特点及手术治疗

目的 :分析额叶癫痫的临床特征、发作期及发作间期脑电图特点 ,探讨额叶癫痫手术治疗。方法 :应用视频脑电图对 9例额叶癫痫患者进行长程监测 ,并对其中 6例记录颅内脑电图。分析癫痫发作的临床表现及脑电图特点 ,定位致痫灶 ,行手术切除。结果 :额叶癫痫的发作特点为 :发作频繁而短暂 ,以睡眠期发作为主 ,常见过度运动 ,姿势性强直 ,发声等发作症状。发作期可见棘波节律 ,广泛低幅快活动 ,节律性慢波等特征性脑电活动。颅内电极记录可清晰显示异常脑电活动的发作起源及扩散情况 ,有助于定位致痫灶。手术切除病灶及致痫灶 ,效果满意。结论 :额叶癫痫是一组具有特征性的癫痫综合征 ,颅内电极记录有助于揭示其脑电活动变化。对于难治疗性额叶癫痫 ,准确定位致痫灶是手术成功的关键。     

VEEG对难治性非惊厥发作癫痫的诊断及致痫灶术前定位价值

目的：探讨长程视频脑电图（VEEG）对非惊厥发作癫痫的诊断价值及对难治性癫痫术前定位的意义。方法：对22例难治性非惊厥发作性癫痫患者行VEEG监测,22例行头MRI检查,17例行发作间期PET—CT检查,8例行脑磁图（MEG）检查。对所有患者进行致痫灶术前定位评估后11例行手术治疗,术中皮层脑电图（ECoG）监测结果验证VEEG定位的准确性。结果：22例VEEG监测时间24～48h,共监测到83次非惊厥发作,其中5例（22．72％）监测到既往未曾发现的发作类型。每例均记录到临床发作和相应的发作期脑电异常（2～20次）,18例（69次）提示局灶起源（额叶起源6例,颞叶起源7例,额颞叶起源5例）,其中12例（54次,占78．26％）发作起始区与症状产生区一致。VEEG定位的致痫灶区与头MRI有结构异常者符合率为100％,与PET—CT符合率为82-35％,与MEG符合率为100％,与11例手术治疗患者的ECoG监测结果一致（符合率100％）。结论：VEEG可提高癫痫患者非惊厥类发作的捡出率,有助于癫痫的分类,比较准确地定位致痫灶,是难治性癫痫术前评估必不可少的检查。     

Ictal emotional expressions of children with partial epilepsy

OBJECTIVE: To systematically analyze the lateralizing and localizing value of ictal emotional expressions (EEs) in children and compare these results with those of earlier adult studies. METHODS: Five hundred fourteen seizures of 100 consecutive children < or = 12 years with partial (61/100 temporal lobe) epilepsy and postoperative seizure free outcome were included in the study. Video recordings of seizures were reviewed by two independent investigators blinded to the patients' clinical data. RESULTS: Thirty-five patients produced EE at least once during their archived seizures, including fear (15), crying (12), smile (9), pain (5), happiness (3), and laughing (in one case). Emotional symptoms were divided into two groups: positive (smile, laughing, and happiness) and negative EEs (fear, crying, and pain). Emotional expressions appeared more frequently during extratemporal (49%) than temporal (26%) lobe seizures (p < 0.05). Positive EEs had an extratemporal dominance (p < 0.05), while frequency of negative EEs did not localize the seizure onset zone. Assessing their lateralizing value, positive EEs were more frequent during right-sided seizures (p < 0.05) while negative EEs did not lateralize the seizure onset zone. Frequency of EEs were independent of patients' ages, age at epilepsy onset or duration of epilepsy. CONCLUSION: This is the first comprehensive childhood study showing that ictal EEs are frequent in childhood and their localizing and lateralizing properties are different from those of adults.     

婴儿痉挛的临床和视频脑电图特征分析

目的总结婴儿痉挛(West综合征)的临床和视频脑电图(Video-EEG)特征。方法对28例婴儿痉挛患儿的临床资料及视频脑电图特征进行同步分析。结果发病年龄2~14月。28例患儿均监测到痉挛发作,发作形式有屈肌型、伸肌型和混合型多种形式,多发生于入睡后不久或睡眠觉醒时,一日内可散发或密集发作。27例患儿可寻找到病因。发作间期脑电图19例表现为背景活动呈典型高峰节律紊乱,9例为背景活动呈变异型高峰节律紊乱。发作期脑电图17例表现为高波幅慢波夹杂棘波爆发-低电压抑制,10例表现为全脑各导呈广泛性低电压抑制,1例表现为假性正常脑电图改变。结论婴儿痉挛的特点:①绝大多数婴儿期内发病;②发作类型特殊;③脑电图有特征性改变,视频脑电图监测对其诊断及分型有重要意义;④绝大多数患儿伴有智力低下或下降,随着年龄的变化可转变成其他形式的发作;⑤绝大多数患儿治疗困难,预后差;仅少数患儿智力发育正常,无病因可寻;药物治疗疗效满意,为特发性癫。     

儿童癫癎发作的临床特征与录像脑电图分析

目的：分析儿童癫痫发作的临床表现和录像脑电图(Video—EEG)特征。方法：对123例年龄9天至15岁癫痫患儿进行Video—EEG监测，记录并同步分析发作时EEG与临床表现。结果：123例中记录到568次发作，分三种类型。1、全面性发作53例201次发作：①婴儿痉挛18例中53次发作，发作期EEG表现为广泛低波幅快活动或高波幅慢波暴发与低电压抑制；②肌阵挛发作12例中79次发作，发作期EEG表现各导联多棘波、多棘慢波；③强直发作10例中24次发作，发作期EEG表现导联低波幅快节律、多棘慢波；④阵挛发作10例中39次发作，发作期EEG表现各导联棘慢波、尖慢波；⑤失神发作3例中6次发作，发作期EEG表现全导联3Hz棘慢波。2、部分性发作67例中339次发作．分别起源于额、中央、顶、颞、枕，其中38例191次发作为继发全身发作。3、混合发作3例中28次发作。结论：Video—EEG有助于临床医师对儿童癫痫的正确分型及指导治疗。