无神经系统定位体征的癫癎大发作患者的EEG和CT分析

目的探讨无神经系统定位体征的癫癎大发作患者的脑电图(EEG)和脑CT变化。方法68例无神经系统定位体征的癫癎大发作患者作EEG及脑CT检查。结果EEG异常率为82．35％，CT异常率为32．35％。CT正常组和异常组中，EEG异常率无明显差异。CT异常率与病程关系不大，但有发病诱因的继发性癫癎CT异常率较无明显原因者显著增高。结论EEG为癫癎诊断的重要电生理检查方法，且有粗略定位意义，而CT能显示脑结构方面的病理改变，有利于查找病因及病变部位。     

脑器质性精神障碍时多种检查的对照研究

对65例除癫痫外的脑器质性精神障碍的多种检查进行了研究,发现65例患者中EEG、头颅CT、HR和神经系统体征的阳性检出率分别为4 1.5％,60.0％,87.5％和30.8％。阳性检出人数明显高于EEG的是CT(x~2=4.2538,P<0.05)和HR(x~2=8.1509;P<0.01)。但有5例仅发现有EEG异常。所以EEG与其它方法适当配合使用将有助于脑器质性精神障碍的诊断。     

62例病毒性脑炎脑电图与临床及CT分析

为探讨病毒性脑炎（病脑）患者脑电图（EEG）与临床及CT之间的关系,将临床确诊的62例病脑患者进行EEG与CT检查,对其EEG异常的阳性率、异常程度与病程、临床表现、CT之间的关系进行比较分析,并作统计学处理。结果发现,发病10天以内EEG中、重度异常39倒（78%）,与10天以后比较有显著性差异（P＜0．001）。EET可表现为三种形式：以弥漫性异常为主（51.5％）;弥漫性异常伴局灶慢波（32．3%）;局灶性异常（16．2%）。EEG与CT之间无明显相关性（P＞0．05）。提示：EEG检查对病脑的诊断、鉴别诊断,以及动态观察病情、判断预后有重大意义。CT不能取代EEG。     

癫痫的不同临床类型与其脑电图和脑CT检查的结果比较

目的;比较癫痫的不同临床类型与其EEG和脑CT的检查结果。方法：本文根据病史、临床表现、EEG（n＝556）与脑CT或MRI（n=427/556)检查结果而确认为癫痫者,共556例。按其病因分为原发性癫痫、继发性癫痫及混合性癫痫三种临床类型,并对其EEG异常率、异常程度、脑波特征以及与脑CT（或MRI）扫结果进行了比较分析。结果：继发性癫痫的EEG异常率、轻度异常者及出现了广泛性、 弥散性慢波者所占百分比均居于其它两类型之首;原发性癫痫的EEG异常率则低于或接近其它两类型,而中、重度异常及痫样放电两者又高于其它两类型;混合性癫痫的异常率、异常程度及脑波特征均介于其它两类型之间。本文还表明,EEG检查对继发性癫痫有近90％的患者是符合脑CT扫描结果的;对混合性癫痫（427例）其异常率（81．76％）却高于脑CT（40．05％）。本文还评价了EEG检查在定侧、定位方面的重要性。结论：EEG与脑CT（或MRI）两种检查手段各有优劣,宜两者兼用,若再结合本文结果综合分析,将有助于提高临床诊疗水平。     

脑电图在脑梗死中的应用分析

目的 探讨 EEG 对脑梗死的诊断价值.方法 回顾性分析92 例急性脑梗死患者的EEG 资料,并与头颅 CT 作对比研究.结果 24 h 内急性脑梗死患者EEG异常率 90.21 %,而头颅 CT 异常率52.17%,两者比较差异有统计学意义.结论 对脑梗死早期EEG检查较CT更为重要,且EEG对脑梗死患者判断病情及预...     

核素脑灌注显像在癫癎诊断及定位中的应用价值

目的探讨SPECT核素脑灌注显像在癫癎诊断及定位中的特点.方法对48例癫癎患者行发作期及发作间期SPECT检查2次,对结果进行分析,并与EEG、CT/MRI 进行对比.结果发作间期SPECT显像结果：48例中发现异常34例;发作期SPECT 检查结果：48例中35例可见明显高灌注,6例基本正常,7例呈局部低灌注.48例患者均行EEG检查,异常32例;36例行CT/MRI检查,异常14例.结论 SPECT脑灌注显像能显示脑血流及功能情况,对于癫癎的诊断及定位具有重要的临床价值.     

急性一氧化碳中毒后迟发性脑病的临床、脑电图、CT分析

目的 探讨一氧化碳中毒后迟发性脑病(DEACMP)的临床、脑电图(EEG)与头颅CT特点.方法 分析56例DEACMP患者的临床、脑电图与CT资料.结果 DEACMP患者的主要临床表现以急性痴呆为特征的神经精神症状及体征.脑电图表现异常率为100％,主要表现为α慢化或消失,弥漫性中高幅θ、δ波,以额或额颞部明显.昏迷时间越长EEG异常率越高,病情越重.头部CT表现为有病理性密度减低区;大脑皮质病变.结论 本病例诊断主要依靠病史、临床表现、EEG、及CT对判断预后有重要价值.     

脑活检在儿童单纯疱疹病毒脑炎诊断中的意义

单纯疱疹病毒(HSV)是散发性病毒脑炎最常见的致死病因。16～31%HSV脑炎患者年龄小于15～20岁,年幼组(小于30岁)预后与抗病毒化疗开始时的神经系统状态有关,特别强调早期诊断的重要性。目前,脑活检是唯一适用的,对HSV脑炎有特异诊断意义的方法,并可用来排除其它临床症状相似的综合征。脑活检指征如下:发热、精神状态异常、CSF淋巴细胞增多、神经系统检查或其它检查有定位症状者。活检标本从经临床症状、体征、EEG和CT扫描提示的最明显的病变区取得,立即制成冰冻切片,进行光镜、常规病理学、电镜、检出HSV抗原的荧光抗体染色检查及HSV培养,同时进行细菌、分支杆菌及真菌培养。活检前12～24小时开始     

TCD、EEG和CT在急性脑梗死中的分析研究

目的 探讨急性脑梗死患者脑血流动力学、脑功能变化和影像学改变及其相关性和临床意义.方法 观察47例急性脑梗死患者的经颅多普勒（TCD）、脑电图（EEG）变化和影像CT改变,分析其与预后的关系.结果 TCD、EEG在急性脑梗死中异常率较高,且EEG异常程度越重,预后越差.结论 急性脑梗死存在不同程度脑血流动力学和脑功能变化,脑梗死患者应尽早进行TCD和EEG检查,结合颅脑CT,以指导治疗和预后判断.     

嗜酒所致精神障碍与脑电图地形图研究

对嗜酒所致精神障碍患者40例脑电地形图（BEAM）进行检查，并与40例无脑部疾病、无酗酒史的正常人进行比较，结果，患者组脑电地形图异常率为25%，伴随脑电图（EEG）轻度异常率22.5%。为研究酒精中毒患者大脑损害程度提供了参考依据。     

Analysis of clinico-social features of epilepsy

The authors studied 286 patients with epilepsy with disease onset past the age of 20 years (176 males, 110 females) from the urban and rural populations. In 57% of cases the aetiology of epilepsy was undetermined. Among the known aetiological factors head trauma accounted for 15.5% of cases, inflammatory processes in the central nervous system for 4.5%, alcoholism for 7%, vascular lesions for 6%, tumours for 5.2%, degenerative and atrophic changes for 1.5%. Over 40% of patients had had attacks for up to 15 years and over 18% for over 20 years. In 80% of cases grand mal seizures occurred, and in 33% of these cases more than 12 attacks occurred annually. Six cases of status epilepticus were observed with 2 deaths. The attacks were precipitated by menstruation, alcohol abuse, infection, stressed, television watching. Among the signs accompanying or following the seizures tongue biting and urination prevailed. Neurological signs were demonstrated in 21% of cases, encephalopathy in 65%, other psychic disturbances in 9.5%. Systematic treatment was received by 75% of the patients (over 80% in urban population), and therapy with multiple drugs was most frequent. Drug-resistant epilepsy was found in 34% of cases. The patients from the rural population had a lower educational level and had more children. About 70% of the patients were in employment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic and electroclinical features of grand mal epilepsies

We studied the electroclinical features and prognosis of 103 patients with tonic-clonic seizures alone. Patients were classified into three groups according to seizure semiology and interictal EEG: primary grand mal, focal grand mal and indeterminate grand mal. Discriminant analysis showed that a number of other electroclinical features had no significant classificatory power. Patients have been followed for 2-10 years. At the last observation 40% of patients were free from tonic-clonic seizures and 23% had fewer than 1 seizure a year, without differences among the three groups. The appearance of 'minor' (absence or partial) seizures during follow-up occurred in 12 patients and did not change the prognosis of tonic-clonic seizures. At the end of follow-up, 96% of patients had a normal social adjustment. Grand mal epilepsies therefore appear to have a good prognosis.     

有癫痫发作的脑型血吸虫病的头颅CT检查和临床表现

目的评价头颅ＣＴ对有癫痫发作的脑型血吸虫病的诊断价值。方法选择５４例有癫痫发作并经临床确诊的脑型血吸虫病，其中大发作２６例，局限运动型癫痫２６例，颞叶癫痫２例。全部病例行头颅ＣＴ检查，并与他们的临床表现、分型、治疗和预后进行比较。结果头颅ＣＴ异常４４例，异常ＣＴ随本病分型不同而有差异。结论头颅ＣＴ检查不但有助于脑型血吸虫病致癫痫病人的诊断，而且对本病的鉴别诊断、分型和指导治疗亦有参考价值。     

Cerebral seizures, alcoholism, and deliria (author's transl)]

The occurrence of cerebral seizures in alcoholics was investigated in case histories of 84 delirious and nondelirious male patients. Eighteen patients had seizures before they became alcoholics; the frequency of the seizures increased during abuse. Twelve had no deliria at all up to the moment of this investigation; in 66 of the patients the occurrence of seizures was assumed to be caused by alcohol abuse alone. Seventy-one patients had seizures irrespective of deliria and nearly 40% of them had no deliria at all. In 21% we observed only deliria with seizures; in 16% only deliria without seizures; and 24% had deliria both with and without seizures. The remaining 13 patients of 84 had only deliria complicated by cerebral seizures; only 3 had deliria without seizures. The seizures occurred as grand mal in 94% of the alcoholics, in all patients with genuine epilepsy, and in 60% of the patients with post-traumatic epilepsy.     

Long-Term Course of Childhood Epilepsy with Intractable Grand Mal Seizures

Abstract: Twenty-nine children with childhood epilepsy characterized by frequent grand mal (generalized tonic-clonic) seizures in spite of maximal doses of antiepileptic drugs and by an early onset of seizures (before 1 :year of age) were followed up for more than 5 :years. The children were divided into 3 :groups: severe myoclonic epilepsy in infancy (SME), no SME, and intractable childhood epilepsy with generalized tonic-clonic seizures (GTC). In all the 3 :groups, the grand mal seizures persisted, whereas the other types of seizures tended to disappear as the patients aged, and the prognosis for mental development was poor. In the majority of cases in all the 3 :groups, the waking grand mal seizures altered to sleep grand mal seizures with aging. Two pairs of monozygotic twins with SME suggested that genetic factors play a role in this epileptic syndrome. Intractable childhood epilepsy with GTC is distinguished by the absence of other types of generalized seizures. It cannot be regarded as an epileptic syndrome, but its pathogenesis and treatment require further studies.     

癫(癎)患者出现新发作类型的临床研究

目的 探讨癫(癎)患者新发作类型出现的比例及可能原因,为正确诊断、治疗和预防癫(癎)提供依据.方法 回顾性研究1074例癫(癎)患者的临床资料,分析癫(癎)患者新发作类型的发生率、可能原因、脑电图和神经影像学结果、家族史及神经系统检查.采用独立样本秩和检验比较有或无新发作类型出现的癫(癎)患者的发病年龄及病程差异.X2检验比较有或无新发作类型出现的癫(癎)患者的性别、家族史、神经系统检查以及脑电图和神经影像学出现异常比例的差异.结果 1074例患者中231例(21.5%)出现新的发作类型,其中部分性发作患者584例,132例(22.6%)出现新的发作类型;全面性发作患者490例,99例(20.2%)出现新的发作类型.1074例癫(癎)患者中脑电图异常者576例(53.6%),影像学异常237例(22.1%).231例出现新发作类型的癫(癎)患者中123例(53.2%)出现脑电图异常,75例(32.5%)影像学异常.有41例患者可找到出现新发作类型的可能原因.有和无新发作类型的癫(癎)患者的首次发病年龄差异无统计学意义,平均病程(Z=2.024)、神经系统体格检查和影像学检查结果有异常的比例(χ~2=23.836、18.511)差异均有统计学意义(P＜0.05).结论 一部分出现新发作类型的患者可找到原因,分析新发作类型的出现、原因对癫(癎)的诊断、治疗和预防有指导意义.     

The postictal electroencephalogram

Postictal phenomena, their laterality and duration, were studied among 51 patients with scalp EEG-recorded seizures whose origin, evolution and postictal phase were clearly depicted. Regional delta was the most common postictal change (PIC), appearing in 29 patients (57%). Regional attenuation occurred in 15 cases (29%) while the EEG reverted immediately to its interictal nature in 16 instances (31%). 'Activation' of spikes postictally occurred after 13 of the 51 seizures (25%), always over the lobe of seizure onset. PIC, whatever its nature, appeared principally or exclusively ipsilateral to seizure origin in all 35 patients. Moreover, when such changes were bilaterally distributed, they persisted longer on the side of seizure origin in all but one case when durations were bilaterally equal. A multiple PIC (greater than 1 phenomenon) occurred after 21 seizures (41%) while a single change appeared after 14 attacks (27%). Multiple changes occurred more commonly when the seizures had evolved to independent bilateral seizures or to grand mal (77%) than when they were confined to the hemisphere of origin (14%). Thus multiple changes were more often distributed bilaterally (90%) than were single changes (29%). Conversely, seizures without any propagation (focal only) were those most likely to show no postictal change. Multiple changes lasted longer (mean 406 sec) than single changes (79 sec), but duration of PIC was unaffected by seizure propagation or its nature, except for grand mal. Seizure duration had no effect on PIC duration except for grand mal attacks whose postictal effects were predictably longer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Longterm follow-up of childhood epilepsy with absences. II. Absence-epilepsy with initial grand mal

The study deals with 83 patients with absence epilepsy which had started with generalized tonic clonic seizures. Only those patients were included, who could be followed up to an age older than eighteen years. The patient population is heterogeneous; it includes numerous older patients in whom therapy had been instituted at a time when the present standard medication with ethosuximide and valproate was not available. Therefore the data cannot be used as a basis for global statements concerning the prognosis of absence epilepsy with grand mal onset. About 80% of the patients treated with standard therapy became seizure free. An unfavourable course was mainly preceded by incorrect, irregular and quantitatively inadequate therapy. Standard therapy cannot prevent singular generalised tonic clonic seizures in the late course. The social status of adult patients is mainly favourable if they are seizure free. Sporadic attacks usually will not impair social integration. In all, absence epilepsy starting with grand mal responds not as well to therapy and has a more unfavourable social prognosis than epilepsy starting with absences.     

Comparison of valporic acid efficacy in familial versus sporadic cases of juvenile myoclonic epilepsy

BACKGROUND: Juvenile myoclonic epilepsy is a heterogeneous syndrome, both in genetic and clinical aspects. AIMS: This study was conducted to compare the efficacy of valproic acid in familial versus sporadic cases of this syndrome. SETTINGS AND DESIGN: Seventy patients with JME were identified; 24 patients (34.3%) had positive history of JME in their first degree relatives (group I) and 46 patients (65.7%) were sporadic (group II). MATERIALS AND METHODS: Valproic acid was started for the patients with upward titration. The cases were followed for one year after final titration of the drug with regular blood monitoring. Patients, who had no myoclonic, absence and grand mal seizures within one year, were considered excellent responders. STATISTICAL ANALYSIS: We used Student T-test and Fisher's exact test for quantitative and qualitative variables respectively. Logistic Regression test was used to evaluate the predictive factors for final treatment outcomes. RESULTS: Mean dosage of valproic acid was 800 mg/d in both groups (13 mg/kg and 12.4 mg/kg respectively). Mean therapeutic levels of the drug in group I and II were 74 microg/ml and 78.4 microg/ml respectively. Excellent responders' rate was 66.7% in group I and 76.1% in group II. History of absences and older age at the onset of grand mal seizures decreased excellent responders' rate in both groups. CONCLUSIONS: Considering response to valproic acid, there is no significant difference in familial versus sporadic cases of JME, whereas history of absences and older age at the onset of grandmal seizures, decrease the probability of being excellent responders in this syndrome.     

Evidence of vascular disease from CT scanning in late onset epilepsy.

The CT scans of 74 patients presenting with late-onset epilepsy not due to cerebral tumour were compared with those of an age and sex-matched control group for evidence of cerebral vascular disease. Changes in the scan indicative of cerebral atrophy (enlarged ventricles and cortical sulci) were seen in similar numbers in both patients and controls. However, the scans revealed a highly significant excess of ischaemic lesions in the epileptic patients, in the form of discrete areas of infarction and low attenuation of the periventricular white matter. These changes, which were only seen in two of the controls, were present in 13 of the epileptic patients. The median age at the onset of epilepsy in the 13 patients with ischaemic lesions was 62 years, and they showed an increased incidence of systemic vascular disease and of abnormal neurological signs. In six of the 13 cases, however, clinical examination was normal and CT scanning provided the only evidence of underlying vascular disease.