视频脑电监测在癫痫诊断中的应用

目的:探讨视频脑电图对癫痫的诊断价值。方法:对596例临床诊断为癫痫的患者分别行2、6、12、24h视频脑电监测,分析临床发作率与痫样放电率、痫样放电与睡眠时相的关系,监测时程与临床发作率、痫样放电率的关系。结果:596例中监测到临床发作98例,其中有同步、痫样放电88例;共记录到痫样放电507例,其中睡眠期461例,仅在Ⅰ、Ⅱ期睡眠期者432例。88例确诊癫痫部分性发作者50例,全面性发作18例,其他发作类型或癫痫综合征20例。6h脑电监测临床发作检出率最低(8.4%),2、24h脑电监测临床发作检出率高(35.7%,19.6%)。结论:视频脑电图可提高痫样放电检出率和临床发作检出率,有助于癫痫的诊断、分型诊断,除发作频率高者外,一般应行至少12h监测以提高痫样放电检出率和临床发作检出率。     

视频脑电图在脑瘫患儿痫性发作监测中的应用

目的:探讨视频脑电图(VEEG)在脑瘫患儿合并痫性发作监测中的应用价值。方法:脑瘫患儿112例分为有发作组(监测前有发作性症状)75例和无发作组(监测前无发作性症状)37例,分别进行VEEG监测4 h,对监测中各种状态及事件进行标记,结束后将记录的脑电图与临床录像资料同步回放并进行统计学分析。结果:有发作组检测到发作60例,其中痫性发作34例,癫痫诊断率45.33%;无发作组检测到痫性发作15例,癫痫诊断率40.54%,2组差异无统计学意义(P>0.05)。结论:临床应重视VEEG在脑瘫患儿中的应用,减少癫痫的误诊和漏诊。     

视频脑电图监测在成人癫痫420例规范诊疗中的应用分析

目的对在成人癫痫规范诊疗中视频脑电图监测的临床价值进行评价分析,为今后诊疗工作提供可靠的参考依据。方法随机抽取在2010年1月～2012年12月间我院收治的成人癫痫临床患者病例420例,对其临床资料展开回顾性分析。结果本组420例患者中,经视频脑电图监测发现痫性放电者346例,有临床发作者215例,发作类型包括;全面强直阵挛性发作、失神发作、肌阵挛发作、强直发作、失张力发作、简单部分性发作、复杂部分性发作等,检出癫痫综合征者169例。结论经视频脑电图监测能够确诊癫痫的发作类型、癫痫综合征,并对脑电-临床关系进行准确评价,为临床规范治疗提供了可靠的参考依据,值得关注。     

动态脑电活动监测对儿童发作性脑疾病的评估(英文)

背景:24h动态脑电图是在常规脑电图基础上延长描记时间,以便对各个状态下的脑电活动进行监测,从而大大提高了癫痫患儿的检出率。目的:通过对癫痫和可疑癫痫患者进行24h动态脑电图监测,探讨其对儿童发作性脑疾病的评估价值。设计:病例分析。单位:江西医学院第二附属医院神经内科。对象:选择2001-07/2004-10江西医学院第二附属医院神经内科住院及门诊的发作性脑疾病患儿151例,其中男99例,女52例,年龄3个月～14岁。根据临床诊断分为两组:癫痫组85例,可疑癫痫组66例。151例患儿中有39例曾行脑电图检查,21例行CT检查,3例行MRI检查。方法:对参加者详细询问病史、神经科查体,进行24h动态脑电图监测(凡在监测期间出现棘波、尖波、棘(尖)慢综合波、爆发性高幅慢波、高度失律波、新生儿单一节律爆发波者,以及过度换气早期突破或局限性爆发性慢波者均为痫样放电;背景波异常,儿童期枕部阵发性慢波,睡眠期极度纺缍波及新生儿散发性一过性尖波,偶见不典型尖-慢波综合均属非特异性异常),并收集常规脑电图、CT或MRI检查结果。主要观察指标:①观察24h动态脑电图对儿童发作性疾病的异常率、痫样放电率。②痫样放电时间、部位、临床发作与异常发作的关系。③将24h动态脑电图对儿童发作性疾病的异常率、痫样放电率与常规脑电图、CT或MRI结果进行对比分析。结果:151例患儿均进入结果分析。①151例患儿动态脑电图监测结果异常122例,其中痫样放电97例。癫痫组痫样放电率明显高于可疑癫痫组犤79%(67/85),45%(30/66),(χ2=18.008,P<0.005)犦。②癫痫组中动态脑电图痫性放电以一侧半球或局限性一侧偏胜以及双侧大脑半球为主,可疑癫痫组中以双侧大脑半球痫样放电出现率最高。③痫样放电时间以睡眠时期为主,占74%(72/97),其中68%(44/97)见于浅睡期。④癫痫组临床发作14例,痫样放电出现率93%(13/14),明显高于可疑癫痫组犤临床发作25例,痫样放电出现率12%(12/25),(χ2=6.741,P<0.01)犦。⑤151例患儿中有39例曾行常规脑电图检查,其中非特异性异常19例,痫样放电7例;动态脑电图中非特异性异常5例,痫样放电29例,两组患儿的常规脑电图以非特异性异常为主,动态脑电图以痫样放电为主。结论:24h动态脑电图用于诊断儿童发作性脑疾病的痫样放电率明显增高,并能确定放电部位及时间,充分体现了动态脑电图对儿童发作性脑疾病评估的优越性。     

动态脑电活动监测对儿童发作性脑疾病的评估

背景:24 h动态脑电图是在常规脑电图基础上延长描记时间,以便对各个状态下的脑电活动进行监测,从而大大提高了癫痫患儿的检出率.目的:通过对癫痫和可疑癫痫患者进行24 h动态脑电图监测,探讨其对儿童发作性脑疾病的评估价值.设计:病例分析.单位:江西医学院第二附属医院神经内科.对象:选择2001-07/2004-10江西医学院第二附属医院神经内科住院及门诊的发作性脑疾病患儿151例,其中男99例,女52例,年龄3个月～14岁.根据临床诊断分为两组:癫痫组85例,可疑癫痫组66例.151例患儿中有39例曾行脑电图检查,21例行CT检查,3例行MRI检查.方法:对参加者详细询问病史、神经科查体,进行24 h动态脑电图监测(凡在监测期间出现棘波、尖波、棘(尖)慢综合波、爆发性高幅慢波、高度失律波、新生儿单一节律爆发波者,以及过度换气早期突破或局限性爆发性慢波者均为痫样放电;背景波异常,儿童期枕部阵发性慢波,睡眠期极度纺缍波及新生儿散发性一过性尖波,偶见不典型尖-慢波综合均属非特异性异常),并收集常规脑电图、CT或MRI检查结果.主要观察指标:①观察24 h动态脑电图对儿童发作性疾病的异常率、痫样放电率.②痫样放电时间、部位、临床发作与异常发作的关系.③将24 h动态脑电图对儿童发作性疾病的异常率、痫样放电率与常规脑电图、CT或MRI结果进行对比分析.结果:151例患儿均进入结果分析.①151例患儿动态脑电图监测结果异常122例,其中痫样放电97例.癫痫组痫样放电率明显高于可疑癫痫组[79%(67/85),45%(30/66),(x2=18.008,P＜0.005)].②癫痫组中动态脑电图痫性放电以一侧半球或局限性一侧偏胜以及双侧大脑半球为主,可疑癫痫组中以双侧大脑半球痫样放电出现率最高.③痫样放电时间以睡眠时期为主,占74%(72/97),其中68%(44/97)见于浅睡期.④癫痫组临床发作14例,痫样放电出现率93%(13/14),明显高于可疑癫痫组[临床发作25例,痫样放电出现率12%(12/25),(x2=6.741,P＜0.01)].⑤151例患儿中有39例曾行常规脑电图检查,其中非特异性异常19例,痫样放电7例;动态脑电图中非特异性异常5例,痫样放电29例,两组患儿的常规脑电图以非特异性异常为主,动态脑电图以痫样放电为主.结论:24 h动态脑电图用于诊断儿童发作性脑疾病的痫样放电率明显增高,并能确定放电部位及时间,充分体现了动态脑电图对儿童发作性脑疾病评估的优越性.     

癫痫病人长程视频脑电监测的护理干预

视频脑电监测是最近发展起来的新型脑电检查手段,可以将癫痫病人发作的临床表现和脑电活动的同步变化在获得病人脑电记录的同时得到病人同期临床表现的录像.视频脑电图可以进行任意时程的监测[1],对于癫痫诊断、鉴别诊断和癫痫手术治疗前的术前定位有重要价值.长程视频脑电监测通过延长记录时间,增加记录发作的机会,分析发作期及间歇期痫性放电,提高痫灶定位的准确性,目的是获得病人发作期的脑电图和具体发作的临床表现[2].     

视频脑电图监测小儿发作性疾病的护理

目的:探讨视频脑电图在小儿发作性疾病中的应用价值。方法:对癫痫组166例,可疑癫痫组49例,应用美国PIVEEG400-C型视频脑电图仪进行3～4h的动态监测,包括至少1个清醒-睡眠周期,完成各种诱发试验。结果:癫痫组VEEG痫性放电124例(74.69%),监测到临床发作26例,其中癫痫发作20例,非癫痫发作6例;可疑癫痫组VEEG痫性放电13例(26.53%),监测到临床发作16例,其中癫痫发作3例,非癫痫发作13例。137例痫性放电的患儿中99例(72.26%)确定了发作类型。43例(31.39%)明确了癫痫综合征的诊断。结论:视频脑电图监测在鉴别癫痫发作性质、确定发作类型方面提供了准确可靠的依据。     

提高癫痫患者视频脑电图监测质量的相关护理

癫痫是一种常见的慢性神经系统疾病,是一组以反复痫性发作为主要特征的慢性综合征。癫痫临床表现多种多样,可分为部分性发作及全身性发作。其中以强直阵挛发作、单纯部分运动性发作及典型的失神发作较为普遍,而特殊类型的癫痫极易引起误诊。视频脑电图(VEEG)是脑电图监测的     

视频脑电监测在非癫痫发作性疾病中的应用及护理配合

目的:提高视频脑电图报告的准确性,帮助鉴别诊断非癫痫性发作(NES)与癫痫性发作.方法:护士配合做好视频脑电监测前的各种准备及监测过程中伪差的观察处理.结果:48例拟诊或疑似癫痫患者最终确诊为NES.结论:在视频脑电监测鉴别NES的过程中离不开护士的有效配合.     

404例癫痫发作的强化分析

目的：（1）探讨各类癫痫发作时症状和脑电图特点及录像脑电图监测（VEEG）在癫痫诊断、分类、定位上的价值。方法：将404例癫痫患者分为2组：1、临床诊断癫痫组，2、临床疑诊癫痫组。采用同步录像脑电图监测仪纪录患者发作时临床和脑电图表现，分析其监测结果。采用医用统计软件包SPSS软件分析，计数资料采用X^2检验。结果：确诊癫痫组患者的痫样放电检出阳性率：VEEG达82．3％，与常规脑电图（REEG）阳性率33．2％有显著性差异。88．7％临床表现为部分性发作的患者，可检出部分性痫样波。结论：VEEG对癫痫患者脑电异常的检出率高于REEG。VEEG可以为部分性癫痫发作提供定位依据。     

So-called late epilepsy (author's transl)

411 patients with epileptic seizures manifest only after the age of 25 were investigated as to aetiology, seizure type and frequency and age and sex distribution. Neurological, neuro-radiological and EEG findings are reported: There was a clear prevalence of male patients (67%). Manifestation occurred mainly between 30 and 40 years of age (65%). Most seizures were primarily of the generalized grand mal type (68%). Grand mal with focal onset occurred in 13%, partial seizures in 11%, complex partial seizures (psychomotor seizures) in 5%, the latter plus grand mal seizures in 2% and other types in 1% of the cases. Aetiological factors were: chronic alcoholism (31%), vascular diseases (17%), tumours (12%), traumatic brain lesions (8,5%), toxic metabolic lesions (6%) and other factors (6%). Idiopathic epilepsy of late onset was a rare cause (4%). The aetiology remained unknown in 15% of cases. We found that the differences in age distribution, seizure type and the EEG findings are significant factors in the differential diagnosis and we compared them with those found in similar investigations.     

Autonomic epilepsy--the influence of epileptic discharges on heart rate and rhythm.

PURPOSE: To study cardiac alterations (changes in heart rate and cardiac arrhythmias) at the transition from the pre-ictal to the ictal state during focal epileptic seizures. METHODS: We assessed ECG changes during 92 seizures recorded with scalp EEG in 30 patients and 35 seizures in 11 patients evaluated with subdural strip and/or grid electrodes. Consecutive RR intervals were analyzed with a newly developed mathematical model for a total of 90 seconds (60 seconds pre-ictal, 30 seconds ictal). RESULTS: We found an ictal tachycardia (heart rate increase > 10 bpm) in 82.5% of seizures, and an ictal bradycardia (heart rate decrease > 10 bpm) in 3.3% of seizures. Bradycardia was only observed in seizures of frontal lobe origin. Heart rate changes occurred several seconds prior to EEG seizure onset on scalp-EEG in 76.1% of seizures, but also prior to EEG seizure onset on invasive EEG in 45.7% of seizures. Early tachycardia occurred significantly more often in temporal than in frontal lobe origin seizures. We found no significant effect of the side of seizure onset on both the quality and quantity of ictal heart rate changes. The occurrence of an aura or of awakening prior to the seizure had no influence on peri-ictal heart rate changes. Low risk cardiac arrhythmias were more frequently observed in frontal lobe origin seizures. CONCLUSIONS: Epileptic discharges directly influence portions of the central autonomic network, within a brain area too small or too deep to be detected on EEG, most likely deep mesial structures such as the amygdala or portions of the hippocampus. The potential clinical applications of our results include (1) automatic seizure detection, (2) differentiation between seizures of temporal and frontal lobe origin, (3) detection of peri-ictal cardiac arrhythmias, and (4) clarification of SUDS (sudden unexplained death syndrome) in epilepsy.     

用脑电双谱分析和人工神经网络预测癫痫发作的研究

目的：根据癫痫患者脑电信号具有非高斯非线性随机特性，应用高阶累积量技术对癫痫患者的脑电信号进行双谱估计，进而结合神经网络研究发作前脑电对癫痫发作预报的价值，以寻求更加敏感和准确的发作预报参量和临床监护方法。方法：对7例癫痫患者在不同发作阶段特别是发作前夕的八导脑电信号进行双谱估计，提取各导脑电的双相关指数和加权双谱权重中心，研究了在不同发病阶段的脑电信号的高斯偏离程度，使用一个四层(24-10-2-1)的神经网络实现分类。神经网络的训练和测试采用去一循环对比法。结果：不同发作阶段时癫痫脑电信号的高斯偏离程度明显不同，其中双相关系数能够敏感区分癫痫的不同发作阶段；双相关系数和加权双谱中心作为人工神经网络输入时可提前12-24s预报癫痫的发作。结论：双谱分析、双相关系数为癫痫脑电信号的研究提供了一些新的思路，有望成为临床监护预报癫痫发作的一个指标。     

Seizure development after stroke

Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.     

42例缺血性卒中后癫痫发作危险因素探讨

目的：研究缺血性卒中患者继发早期癫痫发作和晚期癫痫发作的发病率、发作类型及缺血性卒中继发癫痫发作的临床危险因素。方法：分析山西省人民医院近3年来首发缺血性卒中的408例患者的年龄、性别、入院时意识、糖尿病、高血压、心源性疾病和卒中部位等的临床特征,随访6~12个月,其中缺血性卒中后继发癫痫发作患者42例,未继发癫痫发作患者366例。缺血性卒中后癫痫发作的患者依据癫痫发作的发生时间分为早期癫痫发作组（18例）和晚期癫痫发作组（24例）。分析缺血性卒中后早期癫痫发作和晚期癫痫发作的发病率、发作类型以及缺血性卒中后发生继发癫痫发作的临床危险因素。结果：缺血性卒中后癫痫发作的发病率为10.3%（42/408）,其中早期癫痫发作的发病率为4.4%（18/408）;晚期癫痫发作的发病率为5.9%（24/408）。早期癫痫发作的50.0%（9/18）为全面性强直-阵挛发作,晚期癫痫发作的58.3%（14/24）为单纯部分性发作。缺血性卒中后癫痫发作组与非癫痫发作组的临床特征经统计学比较,两组间心源性脑栓塞病例的发生率和累及皮质梗死的发生率比较差异有显著性（P〈0.05）。结论：缺血性卒中后早期癫痫发作以全面性发作为主,晚期癫痫发作以单纯部分性发作为主;心源性脑栓塞和累及皮质梗死是缺血性卒中后癫痫发生的危险因素。     

Role of head computed tomography in the evaluation of children admitted to the paediatric intensive care unit with new‐onset seizure

Objective: The role of neuroimaging in children presenting with new‐onset seizure is poorly defined. This study evaluates the incidence of abnormal CT findings in children admitted to the paediatric intensive care unit (PICU) with new‐onset seizure and examines potential clinical variables associated with abnormal head CT findings. Methods: A retrospective analysis of 89 previously asymptomatic children admitted to Sydney Children's Hospital (Sydney, Australia) PICU between November 2005 and September 2009 with new‐onset seizure was undertaken. Demographic data, clinical details and head CT findings were abstracted from medical records. The clinical significance and the impact of CT findings on acute management decisions was analysed. Clinical variables associated with abnormal clinically significant CT results were examined. Results: A total of 71/89 patients underwent head CT. Of the children who underwent head CT (n= 71), clinically significant CT results were found in 19.7% of patients and head CT findings resulted in a change in acute management in 7% of patients. Children without fever were more than twice as likely to have a positive CT scan (P= 0.049); however, a substantial proportion (6/45) of febrile children also had abnormal scans. Focal seizures were not predictive of abnormal CT results. There was a significant relationship between abnormal CT and multiple seizures (P < 0.02), and age less than 24 months (P < 0.049). Conclusion: In this highly selected group head CT findings are frequently abnormal and might change acute management. Children admitted to the PICU with first presentation of seizure who have multiple seizures and/or are aged <2 years should have immediate CT or MRI scanning.     

良性婴儿癫痫的临床及发作期脑电图特征

目的：进一步阐述良性婴儿癫痫（BIE）的临床发作及发作期脑电图（EEG）特征,以便早期识别此病,合理治疗及评估预后。方法对21例符合BIE诊断标准的患儿临床发作及视频脑电图（VEEG）进行分析,并对治疗及预后进行随访。结果患儿发病年龄3～11个月。19例发作初期有丛集性特点。主要表现形式为：头、眼歪斜,面肌、眼睑或肢体阵挛,肢体肌张力增高或四肢松软,意识丧失,活动停止,青紫,反应迟钝,凝视,自动症。所有患儿发作间期EEG正常。13例VEEG监测到19次发作,显示发作期放电均为局灶起源,2例5次发作为左侧后颞区起源,3例4次发作为左侧中颞区起源,2例3次发作为右侧中颞区起源,3例4次发作为左枕区起源,1例1次发作为右枕区起源,左右顶区起源各1例。痫样放电持续时间55～126 s。所有患儿均单药治疗,左乙拉西坦11例,德巴金糖浆9例,奥卡西平1例,17例于1个月内发作控制。疗程1年,随访时间2～3年,无1例复发,患儿精神运动发育正常。结论 BIE丛集性发作突出;发作期EEG以颞区放电为主;此病预后良好,可缩短抗癫痫疗程。     

CaBP4基因突变与儿童癫痫的相关性研究

目的　探究钙连接蛋白4（Ca2+-bingding protein 4,CaBP4）基因突变与小儿癫痫的相关性。方法　选取2016 年3 月~2018 年3 月在陕西省友谊医院就诊的儿童癫痫60 例,所有患儿均符合国际抗癫痫联盟以及中国癫痫的诊断标准。 通过检测CaBP4 基因突变分布情况,分析CaBP4 基因突变与癫痫患儿首发病年龄、月发作频率、发作程度及发作类型 间的相关性。结果　60 例癫痫患儿中,CaBP4 基因p.G155D 突变阳性患者为33 例（55.0%）,CaBP4 基因未突变患儿 27 例（45.0%）。CaBP4 基因突变与小儿癫痫性别无关,差异无统计学意义（χ2=0.156, P ＞ 0.05）。CaBP4 基因突变与 小儿癫痫首发病年龄有关,CaBP4 基因p.G155D 突变患儿首发病年龄低于CaBP4 基因未突变患儿,差异具有统计学意 义（t =9.752, P ＜ 0.05）。CaBP4 基因突变与小儿癫痫月发作频率和发作程度有关,其中CaBP4 基因p.G155D 突变患儿 月发作频率高于CaBP4 基因未突变患儿,差异有统计学意义（t =11.352, P ＜ 0.05）。重度发作CaBP4 基因p.G155D 突 变患儿高于CaBP4 基因未突变重度患儿,差异有统计学意义（χ2=7.482,P ＜ 0.05）。CaBP4 基因突变与小儿癫痫发作 类型有关,CaBP4 基因p.G155D 突变患儿简单部分性发作率、复杂部分性发作率、强直- 阵挛发作率显著高于CaBP4 基因未突变患儿,差异均有统计学意义（χ2=9.962, P ＜ 0.05）。CaBP4 基因突变与癫痫患儿首发病年龄、月发作频率、 发作程度、发作类型有关,差异有统计学意义（P ＜ 0.05）。结论　CaBP4 基因p.G155D 突变,癫痫患儿首发病年龄越早、 月发作频率越高、发作程度越严重,癫痫发作类型不同,CaBP4 基因p.G155D 突变率存在差异。     

In vivo detection of cortical optical changes associated with seizure activity with optical coherence tomography

The most common technology for seizure detection is with electroencephalography (EEG), which has low spatial resolution and minimal depth discrimination. Optical techniques using near-infrared (NIR) light have been used to improve upon EEG technology and previous research has suggested that optical changes, specifically changes in near-infrared optical scattering, may precede EEG seizure onset in in vivo models. Optical coherence tomography (OCT) is a high resolution, minimally invasive imaging technique, which can produce depth resolved cross-sectional images. In this study, OCT was used to detect changes in optical properties of cortical tissue in vivo in mice before and during the induction of generalized seizure activity. We demonstrated that a significant decrease (P < 0.001) in backscattered intensity during seizure progression can be detected before the onset of observable manifestations of generalized (stage-5) seizures. These results indicate the feasibility of minimally-invasive optical detection of seizures with OCT.OCIS codes: (110.4500) Optical coherence tomography, (170.3880) Medical and biological imaging, (100.2960) Image analysis