蝶骨电极加剥夺睡眠脑电图对癫痫的诊断

目的 探讨蝶骨电极加剥压睡眠脑电图（ＥＥＧ）对癫痫诊断的价值。方法 对１１０例癫痫患者进行常规电极和蝶骨电极描记,如无痫样放电,再作蝶骨电极加过度换气和蝶骨电极加剥夺睡眠,并与常规电极作比较。结果 常规电极痫样放电检出率为３８．１％,单纯蝶骨电极,蝶骨电极加过度换气和蝶骨电极加剥夺睡眠痫样放电检出率常规电极分别提高１１％（Ｘ＾２＝２．６,Ｐ〉０．０５）,１９．２％（Ｘ＾２＝８．１１,Ｐ〈０．０１）     

蝶骨电极对颞叶癫痫致痫灶手术的定位价值

目的 探讨蝶骨电极脑电图对颞叶癫痫致痫灶手术的定位价值。方法 对５２例颞叶癫痫病人在手术前用常规电极和蝶骨电极描记脑电图，确定癫痫病灶。在手术中描记皮层电图（ＥＣ０Ｇ）及深部脑电图（ＤＥＥＧ）。结果 用蝶骨电极描记者无前痫样放电（１００％），其中９０％局限于颞叶；而常规头皮电极发现有痫样放电４６例（８８％），局限于颞叶者只占４６％。术中ＥＣ０Ｇ和ＤＥＥＧ证明所有病人的颞叶表面、海马或杏仁核均有痫样     

24小时动态脑电图监测对不典型癫痫的诊断价值

目的 探讨24小时动态脑电图（AEEG）监测对不典型癫痫的诊断价值。方法 对21例临床上疑似癫痫，但发作不典型的患者作24小时AEEG检测，并结合临床进行观察。结果 21例常规脑电图（REEG）均未见痫样放电，而AEEG可检测到多次阵发棘波，尖波，棘慢波综合，尖慢波综合等痫样放电，并经抗癫痫药均获得控制，故可诊断为癫痫。结论 24小时AEEG监测能帮助临床上诊断不典型的癫痫患者。     

蝶骨电极检查对颞叶癫痫致痫灶定位的意义

分析５２例蝶骨电极对颞叶癫痫致痫灶的手术定位，发现蝶骨电极均能查出痫样放电，局限于颞叶者为９０．３８％（Ｐ＜０．０１）。手术中皮层电图（ＥＣｏＧ）及深部电极（ＤＣｏＧ）描记，证实全部病例颞叶表面或海马、杏仁核均有痫样放电，表明蝶骨电极检查的可靠性，不仅可提高颞叶癫痫脑电图的阳性率且有助于手术定位     

长程蝶骨电极脑电图对颞叶痫灶的定位价值探讨

目的 探讨长程蝶骨电极脑电图对颞叶痫灶的定位价值.方法 回顾性分析经手术治疗的119例颞叶癫痫患者,将其术前的常规脑电图 蝶骨电极(以下简称常规蝶骨电极)与视频脑电图 长程蝶骨电极脑电图(以下简称长程蝶骨电极)检测结果进行分析,其定位结果与术中描记的皮层脑电图(ECoG)及深部脑电图(DEEG)结果进行比较.结果 痫样放电在常规蝶骨电极和长程蝶骨电极的总检出率分别为68.9%和94.1%;其定侧率各为67.1%和99.1%(P＜0.005).术中脑电图证实了术前的长程蝶骨电极脑电图定位准确率高,DEEG与长程蝶骨电极定位吻合率达98.2%.本组随访1～5年,总有效率为97.4%,效果优良为88.6%.结论 长程蝶骨电极对颞叶痫样放电的检出和定侧率高,且准确率高.准确定位可提高手术疗效.     

MRI异常癫痫患者瞬态地形图定位研究

目的：研究临床癫痫发作的患者ＩＢＥＡＭ“致痫灶”与其头部ＭＲＩ有异常病变以及ＶＥＥＧ有棘波、尖波或棘慢波、尖慢波发放的符合率。方法：利用２４小时ＶＥＥＧ（视频脑电图）监测癫痫患者；选出头部ＭＲＩ有异常改变、ＶＥＥＧ有棘波、尖波、棘慢波、尖慢波发放的患者４６例，进行ＩＢＥＡＭ描记。结果：ＭＲＩ显示病变部位和ＩＢＥＡＭ彩色图形显示一致者１９例，符合率为４１．３％。基底节病变，其ＩＢＥＡＭ亦以病变侧，或双侧颞、颞顶部显示。结论：ＩＢＥＡＭ和影像检查相配合，可为“致痫灶”提供较可靠指标。今后结合无创性“偶极子”定位法研究，将会使癫痫患者“致痫灶”的定位可靠性大大提高     

MRI异常癫痫患者瞬态地形图定位研究

目的：研究临床癫痫发作的患者Ｉ－ＢＥＡＭ“致痫灶”与其头部ＭＲＩ有异常病变以及Ｖ－ＥＥＧ有棘波、尖波或棘慢波、尖慢波发放的符合率。方法：利用２４小时Ｖ－ＥＥＧ（视频－脑电图）监测癫痫患者；选出头部ＭＲＩ有异常改变、Ｖ－ＥＥＧ有棘波、尖波、棘慢波、尖慢波发放的患者４６例，进行Ｉ－ＢＥＡＭ描记。结果：ＭＲＩ显示病变部位和Ｉ－ＢＥＡＭ彩色图形显示一致者１９例，符合率为４１．３％。基底节病变，其Ｉ－ＢＥＡ     

100例癫痫发作间歇期脑电图分析

目的 探讨癫痫发作间歇期脑电图的变化相。方法 收集门诊已确诊为癫痫间歇期病人100例,按国际导联10-20系统安置头皮电极,在觉醒状态下,取坐姿进行单极导联描记,常规以过度换气,争开眼反应作常规诱发试验。结果 显示异常率为77%,其中,出现癫痫样或可疑癫痫样放电占27%。结论 若提高阳性率,需反复多次进行脑电图检查,本文亦说明癫痫患者发作间歇期大脑皮层功能似有不同程度的损害。目前脑电图仍是一种脑功能检查的重要手段。     

癫痫3例误诊分析

1病例资料 病例1：患者，女，29岁。发作性右眼盲点7 a。7 a前患者开始无明显诱因出现发作性右眼盲点，为右眼外下方视野缺损，持续约1 min后自行缓解。发作后对发作过程能回忆，感右眼干涉，伴顶枕部胀痛不适，持续约半小时恢复正常。发作时不伴意识障碍、黑蒙、瞪视、闪光、视物变形、眩晕、肢体抽搐及麻木无力，无精神异常，无恶心、呕吐、胸痛及大小便失禁。未引起重视。之后上述症状反复发作，劳累、用眼过度及精神紧张时发作频繁，发作与月经周期无相关性。5d前患者再次发作右眼盲点，伴运动性失语，持续约3 min缓解。患者的孕产正常，否认产钳助产史，精神、运动发育均正常，任护士，现已婚，顺产1女，否认流产及长期服用避孕药物。8a前因车祸致脑震荡出现短暂意识丧失，失忆约半年，至今仍有部分记忆未恢复。否认高热惊厥、脑炎、中毒、抽搐、晕厥、精神疾患等病史。家族史无特殊。神经系统检查无异常。心电图、眼底镜、头颅M RA、颈动脉及椎动脉彩超等未见异常。头颅M RI可见左侧额顶叶一大小约0.8 cm ×1.2 cm蛛网膜囊肿。常规脑电图未见异常。行剥夺睡眠＋毫针蝶骨电极脑电图监测（检查前1d剥夺睡眠18h，次日上午照常饮食和活动，采用国际10～20系统头皮电极，安置蝶骨电极，蝶骨电极描记中行过度换气和闪光刺激试验），监测过程中无类似临床发作，发作间期右侧枕叶可见节律性慢波发放，右侧额顶叶可见少许散在慢波突出背景，未见棘波、尖波、多棘慢波及高节律性紊乱等痫样放电波。诊断：局灶性癫痫（枕叶癫痫）。给予卡马西平0.1 g ，bid后随访6个月未再发作。     

脑瘤伴癫痫发作患者的脑电图和临床

本文分析1961年至1986年12月经手术证实为幕上脑肿瘤(不包括转移癌)的769例中有癫痫发作的169例脑电图及有关临床资料。 资料与方法 169例有癫痫发作的天幕上肿瘤患者的脑电图按10/20国际电极安置法放置18～19个电极,作以耳垂为参考电极的单极,及三个双极导联描记,少数还增作横联,描记20～30分钟,除睁闭眼外,大部分病人作3分钟过度换气试验。 结果 在769例中,169例有癫痫发作史,男96     

Sphenoidal EEG recording in complex partial seizures

A prospective study was performed to evaluate the usefulness of sphenoidal EEG recording during wakefulness, as compared to routine tracings awake and asleep, for recognizing epileptic electroencephalographic foci in patients with complex partial seizures. Fifty patients were investigated. Following sleep deprivation a routine waking EEG, a sleep tracing and an awake recording with sphenoidal needles were obtained. In nine patients temporal epileptiform activity was apparent in all three conditions (wakefulness, sleep and with sphenoidal electrodes). In 21 patients temporal epileptiform activity was seen during sleep only, while the sphenoidal leads were non-contributory. In 20 patients epileptiform activity was not recorded under any of the above conditions. This study indicates that sphenoidal recording during wakefulness does not contribute to the detection of epileptic discharges in patients with complex partial seizures.     

Sphenoidal EEG recording using acupuncture needle electrode in complex partial seizure.

Sphenoidal EEG recording using an uninsulated acupuncture needle electrode were performed in 41 patients with or suspected of complex partial seizures of temporal lobe origin. The anterior temporal spikes were detected by the routine EEG in 17 patients (41%) and by the acupuncture sphenoidal needle in 29 patients (70%). The anterior temporal spikes recorded by the acupuncture needle were almost identical in configuration, amplitude and distribution to those recorded by conventional wire or insulated needle sphenoidal electrodes. The sequence in the frequency of spike detection by these 3 types of sphenoidal electrode were SP1-2, T1-2, F7-8 and A1-2 locations. The spikes of maximal amplitude were most frequently recorded by the SP electrode followed by the T1-2 electrode. The placement of the disposable acupuncture needle was simple and safe. Patients experienced minimal discomfort or pain that lasted at most 0.5 h. No complications occurred. The records were generally free of artifacts. It is concluded that the acupuncture needle can be used as sphenoidal electrode in outpatient EEG recording for the diagnosis of complex partial seizures of anterior temporal-origin.     

Sphenoidal electrodes THEIR USE AND VALUE IN THE ELECTROENCEPHALOGRAPHIC INVESTIGATION OF COMPLEX PARTIAL EPILEPSY

The diagnostic value of sphenoidal electrode EEG recordings in patients with seizures characteristic for epilepsy with complex partial symptomatology was assessed in a study comprising 404 patients; 71.3% of the patients had seizures with automatisms and amnesia, and 28.7% had psychic seizures with subjective phenomena such as hallucinations and illusions. A total of 59.6% of the patients had diagnostic EEG changes in routine waking or sleep EEG. In sphenoidal EEG recording including thiopenthone activation, diagnostic changes were found in 40.5% of the patients without specific changes in waking or sleep EEG, the chance of a positive finding being more than five times higher in patients with automatisms than patients with psychic seizures. Apart from cases where surgical treatment of temporal lobe epilepsy is considered, sphenoidal electrode EEG recording, including intravenous thiopenthone activation, should be performed in patients with seizure phenomena raising suspicion of epilepsy with complex partial symptomatology but where waking and sleep EEGs fail to demonstrate specific abnormalities.     

Neocortical propagation in temporal lobe spike foci on magnetoencephalography and electroencephalography

Propagation of the neuronal population of the interictal epileptic spike was quantified in 5 patients with complex partial epilepsy arising from temporal lobe using electroencephalography and magnetoencephalography. During the spike complex in each patient there was a spike at the deep sphenoidal electrode and a spike at the superficial scalp electrode on spontaneous electroencephalography. In each patient the sphenoidal spike had a different peak latency than the scalp spike, consistent with spike propagation. Electroencephalography was used to trigger two magnetoencephalographic averages of stereotyped spikes during the sphenoidal peak and the scalp peak. Magnetoencephalography discriminated the centers of two cortical spike populations at different latencies, showing deeper localization with sphenoidal trigger and more superficial localization with scalp trigger in each patient (p less than 0.05). Latency differences and propagation distances of spikes were consistent with the conduction velocity of corticocortical fibers. Noninvasive estimates of the cortical surface area of the spikes agreed with estimates obtained by electrocorticography over temporal neocortex. These findings indicate propagation of neuronal populations active during human interictal spikes between deep and superficial cortex of temporal lobe, likely by monosynaptic or oligosynaptic pathways. This interictal system appears to be partly independent of the hippocampal interictal system in complex partial epilepsy.     

Combined use of sphenoidal electrodes and the dipole localization method for the identification of the mesial temporal focus

We attempted to sub-classify four cases who show temporal spikes on standard scalp electroencephalogram (EEG), using sphenoidal electrodes and the dipole localization METHOD: In a case with mesial temporal epilepsy, spikes showed phase reversal in a sphenoidal electrode, and the spike dipoles were estimated to be in the mesial temporal lobe. In a case with lateral temporal epilepsy, spikes showed no phase reversal in a sphenoidal electrode, and the spike dipoles were estimated to be in the lateral temporal lobe. In two cases out of four, spikes showed phase reversal in sphenoidal electrodes, whilst the dipoles were estimated to be in the frontal lobe. Clinical features also suggested a diagnosis of frontal lobe epilepsy. In one of the two cases in which frontal lobe epilepsy was suspected, ictal dipoles as well as interictal spike dipoles indicated participation of the frontal lobe in the genesis of seizures. Nevertheless, only mesial temporal lobectomy was performed based on results obtained by invasive subdural electrodes. As a result, seizures were not controlled. Although sphenoidal electrodes were useful for differentiating between mesial and lateral temporal lobe foci, it is advisable to use them in combination with the dipole localization method to identify frontal lobe foci.     

Status Epilepticus of Benign Partial Epilepsies in Children: Report of Two Cases

Benign partial epilepsies of childhood (BPEC) are one of the most frequent types of epilepsy in school-age children. Status epilepticus (SE) of these conditions have not yet been reported. Two children with clinical and EEG features consistent with the diagnosis of BPEC-SE are presented. In neither case did SE respond to current antiepileptic medications and stopped only after administration of steroids. At follow-up 1 and 2 years post SE, neurologic and intellectual development have been normal. Differential diagnoses included an atypical benign partial epilepsy, epilepsy with electrical status epilepticus during slow sleep, acquired epileptic aphasia, Lennox-Gastaut syndrome and epilepsia partialis continua.     

Correlation between inter-ictal regional cerebral blood flow and sphenoidal electrodes--recorded inter-ictal spikes in mesial temporal lobe epilepsy

The objective of this study was to assess the reliability of the diagnosis of mesial temporal lobe epilepsy using EEG and sphenoidal electrodes. Inter-ictal 99 m Tc-HMPAO SPECT scans were registered in 21 patients with confirmed mesial temporal lobe epilepsy identified by scalp EEG and sphenoidal electrodes. Visual and quantitative SPECT analysis was performed blind to EEG data. An asymmetry index (AI) was measured from the ratio of two symmetrical regions of interest. A temporal lobe hypoperfusion was defined as an uptake reduced by 5% with respect to the contralateral region. Inter-ictal SPECT abnormalities were observed in 12 out of 21 patients (57%) from both visual and quantitative analysis (focal hypoperfusion in 11 cases, focal hyperperfusion in one case). In seven patients (33%) both visual and quantitative scintigraphy were normal. Abnormal AI was found in 11/15 patients with a high frequency of seizures and in 1/6 patients with a low frequency of seizures. The major data is that the probability to have an abnormal SPECT is statistically correlated to the frequency of the epileptic fits. The couple EEG recordings with sphenoidal electrodes and SPECT is sensitive and reliable in the diagnosis of mesial temporal lobe epilepsy.     

Surface sphenoidal electrode for recording anterior temporal spikes.

Spike analysis was performed to determine if surface sphenoidal electrodes were suitable substitutes for depth sphenoidal or anterior temporal electrodes in outpatient EEG recordings for the diagnosis of complex partial seizures of anterior temporal origin. Spike measurements consisted of spike detection rate, spike amplitude, and location of maximal amplitude spikes. Depth sphenoidal electrodes had the highest yield in these three measurements. Surface sphenoidal electrodes did not differ from anterior temporal electrodes in spike detection rate and spike amplitude, but the former recorded almost no maximal amplitude spikes, while the latter had approximately 30% of the maximal spikes. It is concluded that surface sphenoidal electrodes are slightly inferior to anterior temporal electrodes, but the differences between them are minimal for practical purposes in outpatient EEG recordings.