脑电与心电同步检测对癫痫性与心律失常性晕厥的鉴别诊断价值

目的 :探讨 2 4小时脑电 /心电同步监测对癫性晕厥和心律失常性晕厥的诊断和鉴别诊断价值。方法 :对 72例临床怀疑癫性晕厥和心律失常性晕厥患者进行 2 4小时动态脑电图 (AEEG) /心电图 (ECG)同步监测。结果 :①癫性晕厥 42例中 ,EEG总异常率 83 91%。样放电出现率71 2 4% ;心电图显著异常率 19% ;②心律失常性晕厥 2 1例中 ,EEG总异常率 2 4% ,样放电出现率 5 % ,心电图显著异常 91% ;③可疑癫性晕厥 4例中 ,AEEG样放电 1例 ;④可疑心律失常性晕厥 3例 ,ECG均为非显著异常 ;⑤晕厥原因不明 (癫与心律失常两种疾病并存 ) 2例 ,均检出样放电及显著心律失常。结论 :2 4小时EEG/ECG同步监测对癫性晕厥和心律失常性晕厥有重要的诊断和鉴别诊断的价值。     

76例经颅多普勒(TCD)异常患者的临床脑电图(EEG)分析

目的：研究经颅多谱勒(TCD)异常患的脑电图(EEG)异常率。方法：对76例TCD异常患：EEG按病史归类进行分析。结果：既往病史正常EEG示轻度异常5例(5／32)，颈椎病EEG示轻度异常3例(3／17)，本组轻度异常率与正常人(15％轻度异常)相比无差异性，而高血压与糖尿病组EEG示轻度异常6例(6／27)，中度异常4例，与正常人群有显差异。结论：TCD异常患的脑电图异常率与其原有疾病有关。     

颅脑术后继发癫的脑电图表现

&&颅脑术后继发癫的脑电图表现@齐伟 @吴厚慧&&     

Cynomorium songaricum extract enhances novel object recognition, cell proliferation and neuroblast differentiation in the mice via improving hippocampal environment

Background

Increasing numbers of reports show the beneficial effects of listening to Mozart music in decreasing epileptiform discharges as well as seizure frequency in epileptic children. There has been no effective method to reduce seizure recurrence after the first unprovoked seizure until now. In this study, we investigated the effect of listening to Mozart K.448 in reducing the seizure recurrence rate in children with first unprovoked seizures.

Methods

Forty-eight children who experienced their first unprovoked seizure with epileptiform discharges were included in the study. They were randomly placed into treatment (n?=?24) and control (n?=?24) groups. Children in the treatment group listened to Mozart K.448 daily before bedtime for at least six months. Two patients in the treatment group were excluded from analysis due to discontinuation intervention. Finally, forty-six patients were analyzed. Most of these patients (89.1%) were idiopathic in etiology. Seizure recurrence rates and reduction of epileptiform discharges were compared.

Results

The average follow-up durations in the treatment and control groups were 18.6?±?6.6 and 20.1?±?5.1 months, respectively. The seizure recurrence rate was estimated to be significantly lower in the treatment group than the control group over 24 months (37.2% vs. 76.8%, p?=?0.0109). Significant decreases in epileptiform discharges were also observed after 1, 2, and 6 months of listening to Mozart K.448 when compared with EEGs before listening to music. There were no significant differences in gender, mentality, seizure type, and etiology between the recurrence and non-recurrence groups.

Conclusions

Although the case number was limited and control music was not performed in this study, the study revealed that listening to Mozart K.448 reduced the seizure recurrence rate and epileptiform discharges in children with first unprovoked seizures, especially of idiopathic etiology. We believe that Mozart K.448 could be a promising alternative treatment in patients with first unprovoked seizures and abnormal EEGs. Further large-scaled study should be conducted to confirm the effect.

Trial registration

NCT01892605, date: June-19-2013     

老年迟发性癫Xian发作的病因、临床表现及脑电图特征分析

目的：探讨老年迟发性癫Xian发作的病因、临床特点及脑电图特征。方法：对98例老年迟发性癫Xian发作患者的病因、临床发作类型及治疗结果进行统计分析。结果：73例有明确病因，分别为脑血管病45例，脑肿瘤16例，脑外伤5例，脑萎缩5例，血液病2例；临床发作为部分性发作68例（单纯部分性发作44例，复杂部分性发作24例），全面性发作26例，不能归类的发作4例；脑电图正常21例，异常77例，异常脑电图主要表现为低至中幅慢波增多，呈弥漫性或局限性分布，77例异常脑电图中9例出现癫Xian样放电，临床疗效：完全控制44例（45％），部分控制24例（25％），无效10例（10％），死亡20例（20％）。结论：老年迟发性癫Xian大部分病因明确。临床以部分性发作为主，脑电图以慢波活动为背景，癫Xian样放电阳性率低，临床完全控制率低。     

动态脑电图在晕厥诊断中的作用

目的：分析动态脑电图在晕厥诊断中的作用。方法：回顾分析了30例晕厥病人动态脑电图资料。结果：30例常规脑电图基本正常的患者约有57.6%（17例）动态脑电图出现异常,43.3%出现癎样放电。结论：动态脑电图提高了诊断的阳性率,有助于临床鉴别诊断。     

Emergency EEG and factors associated with nonconvulsive status epilepticus.

The purpose of this study was to identify factors associated with nonconvulsive status epileptics (NCSE) and optimize efficient use of emergency electroencephalography (EEG) services. A retrospective review of medical records identified features associated with NCSE over a 1-year period. Seventy-eight EEGs were identified and divided into four groups. Group I, normal EEG; group II, EEG slowing; group III, epileptiform discharges; and group IV, NCSE. Three risk factors were associated with EEG-confirmed NCSE. These three risk factors are: history of epilepsy, witnessed seizure around the time of presentation, and seizure-like motor activity (SLMA). At least one of these three risk factors was identified in 35 patients, and all of the patients with NCSE were within this group. Forty-three patients had absence of these factors, and none of these patients were found to have NCSE, giving these factors a negative predictive value of 100%. Our study suggests that these three factors are highly associated with NCSE. A prospective study should be done to confirm this finding.     

头颅术后继发癫痫的脑电图分析

目的：了解头颅术后继发性癫痫的脑电图改变特点与手术的关系。方法：对头颅手术后癫痫发作的27例病人的脑电图及临床进行分析。结果：正常脑电图3例，异常24例，异常率89％(局限性异常22例，广泛性异常2例)，局限性异常中，一侧性慢波异常6例，区域性慢波异常14例，痫样放电2例。广泛性异常中，中度异常1侧，重度异常l例。结论：头颅术后继发性癫痫的脑电图局限性异常占总异常的92％，而痫样放电仅占4％，局限性慢波与痫样放电的出现与术前病灶、手术部位、术后继发性病灶的部位有关。     

癫(癎)患者抗癫(癎)治疗时脑电图和发作诱因与再发关系

目的:探讨癫癎患者在药物治疗中脑电图、发作诱因与再发的关系,企为临床治疗提供参考指标。方法:分别对97例青少年癫癎患者行脑电图检查并追踪再发情况,比较脑电图、发作诱因与临床再发之间的关系。结果:97例患者中有49例脑电图正常,其中9例(18％)有癫癎再发,48例脑电图异常,其中38例(79％)有癫癎再发。此38例癫癎再发分别属于Ⅰ、Ⅱ、Ⅲ型异常脑电图,相应各有8、11、19例再发。脑电图正常而出现癫癎再发的9例中,有诱因者8例(89％),无诱因者1例(11％),脑电图异常而出现癫癎再发的38例中,有诱因者20例(53％),无诱因者18例(47％)。结论:青少年癫癎患者抗癫癎治疗时的脑电图表现与临床再发有相关性,其中有癎样放电者出现再发可能性最大。脑电图正常时出现再发常有诱因,而脑电图异常时出现再发常缺乏诱因。     

老年人迟发性癫Xian发作的临床及脑电图分析

目的：探讨老年人迟发性癫Xian发作的临床及脑电图特点。方法：回顾性分析80例老年人迟发性癫Xian的临床及脑电图资料。结果：癫Xian发作的可能因为脑血管病41例（脑梗死30例、脑出血11例）,脑肿瘤19例,脑外伤4例,脑萎缩8例。癫Xian发作的类型为全身强直阵挛发作48例;强直阵挛发作持续状态2例,失神发作6例,单纯运动性发作17例,单纯体感性发作7例。脑电图正常7例,异常73例。异常脑电图主要表现为弥漫性慢波活动22例,局限于一侧半球的慢波活动34例,散在或阵发性棘波、尖波或棘慢、尖慢综合波49例。结论：脑血管病（脑梗死、脑出血）、脑肿瘤是老年迟发性癫Xian发作的主要原因。癫Xian发作以全身强直阵挛发作为主。脑电图异常率高,主要表现为在弥漫性慢波活动基础上出现癫Xian样放电。     

抽动障碍儿童EEG痫样放电的临床意义

目的：探讨抽动障碍的视频脑电图（V—EEG）异常率及痫样放电的临床意义。方法：对588例抽动障碍患者进行V—EEG检查并分析其波形特征。结果：该组抽动障碍患儿V-EEG中,正常范围EEG575例,占97．8％,异常EEG（棘尖波发放）13例,占2．2％。结论：抽动障碍患儿的V-EEG异常率并不高,而其中明确与癫痫相关的痫样放电更是少数;抽动障碍患儿中的痫样放电很可能属于正常非癫痫人群中极少数人所具有的临床下放电的情况。     

210例颅脑损伤病人动态脑电监测分析

报告２４ｈ动态脑电图（ＡＥＥＧ）监测２１０例颅脑损伤病人脑电活动，其异常率为８５．２％，略高于文献报道的脑电图及脑电地形图的异常率。其中临床诊断为外伤性癫痫的３０例病人ＡＥＥＧ均异常，２５例有痫样放电（１２例出现于睡眠中）。因此，ＡＥＥＧ的昼夜记录对提高癫痫诊断的阳性率价值很大。１０８例ＣＴ异常的病例中，１０４例ＡＥＥＧ有异常，其阳性一致率为９６．３％；４５例ＣＴ正常中，３０例ＡＥＥＧ有异常，占６６．７％。所以，ＣＴ与ＡＥＥＧ在颅脑外伤诊断中各有所长，不能相互取代。     

儿童非癫癎性发作事件的动态脑电图监测

目的：观察儿童非癫痫性发作事件24h动态脑电图（AEEG）的特点及其诊断意义。方法：对AEEG监测到的121例儿童非癫痫性发作事件临床发作期EEG进行分析，并以常规脑电图（REEG）进行对照。结果：REEG非特异性异常13例10.7%)，AEEG非特异性异常30例，（24.8%），痫样放电3例（2.5%），总异常率27.2%。非特异性异常检出率以偏头痛最高（34.8%），其次为晕厥（23.5%）及睡眠障碍（22.2%）。结论：儿童非癫痫性发作事件AEEG多为正常或非特异性异常，这有助于儿童非癫痫性发作事件的诊断和鉴别诊断。     

癫痫手术治疗的皮层电图监测

目的：探讨皮层电图（ＥＣｏＧ）监测对切除癫痫病灶的应用价值及适应症。方法：对１０４例难治性癫痫患者使用盘状电极行ＥＣｏＧ监测下切除癫痫灶进行研究。结果：术前脑电图（ＥＥＧ）检查８６例异常（８２７％）。皮层电图１０２例异常（９８％）。术后随访３个月至４年,有８８例（８４６％）临床发作已控制,１６例发作次数明显减少。复查常规ＥＥＧ有痫样放电６例,慢波局限性改变５例,其余ＥＥＧ均为正常。术前术后ＥＥＧ阳性率相差显著。结论：在ＥＣｏＧ监测下切除癫痫灶具有一定的临床价值     

Seizures and electroencephalography findings in 61 patients with fetal alcohol spectrum disorders

Fetal alcohol spectrum disorders (FASD) cause neurodevelopmental abnormalities. However, publications about epilepsy and electroencephalographic features are scarce. In this study, we prospectively performed electroencephalography (EEG) and brain magnetic resonance (MR) imaging in 61 patients with diagnosis of FASD. One patient had multiple febrile seizures with normal EEGs. Fourteen children showed EEG anomalies, including slow background activity and interictal epileptiform discharges, focal and/or generalized, and 3 of them had epilepsy. In one patient, seizures were first detected during the EEG recording and one case had an encephalopathy with electrical status epilepticus during slow sleep (ESES). Focal interictal discharges in our patients did not imply the presence of underlying visible focal brain lesions in the neuroimaging studies, such as cortical dysplasia or polymicrogyria. However, they had nonspecific brain MR abnormalities, including corpus callosum hypoplasia, vermis hypoplasia or cavum septum pellucidum. The latter was significantly more frequent in the group with EEG abnormal findings (p < 0.01).     

视频脑电图监测对小儿癫痫的诊断价值探讨

目的探讨视频脑电图(VEEG)对小儿癫痫的诊断价值。方法对102例临床拟诊为癫痫患儿进行4～8h视频脑电图监测,其中包括清醒、睡眠期记录;分析临床发作和异常放电的关系,异常放电出现的时相。结果监测到临床发作并且同步异常放电者23例,仅发作间期癫痫样放电者53例,两者共76例(76/102,74.51%)结合病史确定为癫痫,其中局灶性52例(52/76,68.42%),睡眠中出现55例(55/76,72.37%)。10例(10/102,9.80%)临床发作但无同步异常放电,判定为非癫性发作。结论视频脑电图可提高儿童癫痫诊断的正确率,有助于癫痫的定位,部分剥夺睡眠有助于癫痫样放电的检出率。     

蝶骨电极加剥夺睡眠脑电图对癫癎的诊断

目的：探讨蝶骨电极加剥夺睡眠脑电图（ＥＥＧ） 对癫癎诊断的价值。方法：对１１０ 例癫癎患者进行常规电极和蝶骨电极描记,如无癎样放电,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：常规电极癎样放电检出率为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癎样放电检出率比常规电极分别提高１１ ％ （χ２ ＝ ２ ．６ ,Ｐ＞ ０－０５） ,１９－２ ％ （χ２ ＝８ ．１１ ,Ｐ＜ ０－０１） 和３４－２ ％ （χ２ ＝ １７ ．２２ ,Ｐ＜ ０－０１） 。结论：在上述几种方法中,以蝶骨电极加剥夺睡眠癎样放电检出率最高,故对癫癎诊断的价值最大。     

SCN8A heterozygous variants are associated with anoxic‐epileptic seizures

Anoxic‐epileptic seizures (AES) are rare outcomes of common childhood reflex anoxic syncope that trigger a true epileptic seizure. The term AES was coined by Stephenson in 1983, to differentiate these events from convulsive syncopes and the more common reflex anoxic syncopes. A genetic susceptibility for AES has been postulated; but, its molecular basis has up to now been elusive. We report here two illustrative cases and show the association of de novo SCN8A variants and AES. One of them had focal or generalized seizures and autonomic symptoms triggered by orthostatism; the second had breath‐holding spells triggered by pain or exercise leading to tonic–clonic seizures; both had repeatedly normal EEGs and a family history of reflex syncope. The data of three additional AES patients further suggest, for the first time, a link between SCN8A pathogenic variants and AES. The neurodevelopment of four patients was abnormal. Four of the five SCN8A mutations observed here were previously described in patients with seizure disorders. Seizures responded particularly well to sodium channel blockers. Our observation enriches the spectrum of seizures linked with SCN8A pathogenic variants.     

Wilson病患者及其杂合子亲属的脑电图研究

目的:探讨Wilson病及其杂合子的脑电图改变与临床的关系。方法:记录43例Wilson患者及其60例杂合子亲属的脑电图。结果:43例Wilson病患者脑电图异常率达83.9％,以轻、中度异常改变为主,三组患者间异常率差异不明显(P>0.05);杂合子亲属中脑电图异常率达60.0％,子女组脑电图异常率及异常程度均高于同胞父母组,差异显著(P<0.05和0.01);杂合子亲属脑电图改变有年龄依赖性。Wilson病及杂合子脑电图改变均以弥漫性慢波化、阵发性慢活动和癫痫样放电等为主要表现。结论:1.脑电图可以作为判断肝损型及无症状型患者中枢神经系统临床下损害的有效指征;2.Wilson病杂合子脑电图改变与其年龄密切相关。     

24h-AEEG在可疑癫痫司法鉴定中的应用

目的:探讨动态脑电图(AEEG)在可疑癫痫违法司法精神医学鉴定中的应用价值。方法:对举荐的46例可疑癫痫犯罪人的24小时动态脑电图进行回顾分析。结果:46例中,痫样放电13例(28.3%),非特异性异常8例(17.4%),总异常率为45.7%;痫样放电出现清醒期3例(23.1%),睡眠期出现10例(76.9%),两期有显著性差异(P<0.01);部位多见于额、颞区局限性异常。结论:AEEG因监测时间长,对司法精神医学鉴定中可疑癫痫犯罪的鉴别诊断可提供重要的依据,但不作为责任能力的判定依据。