111例颞叶癫痫患者VEEG、MRI与1HMRS的对比研究

目的：通过对颞叶癫痫患者视频脑电图（VEEG）、核磁共振（MRI）和氢质子波谱分析（^HMRS）的对比研究,评价^1HMRS在癫痫灶定位诊断的价值。方法：111例癫痫患者均行24小时VEEG、双侧颞叶单体素^1HMRS、MRI检查,比较患者发作期及发作间期异常脑电图出现的部位与^1HMRS异常部位的相关性;比较MRI ^1HMRS在颞叶癫痫患者的定位诊断意义。结果：111例患者中未出现临床发作共75例,其中有73例VEEG异常,占患者总数的65.76%,有36例出现临床发作,占患者总数的32.43%;MRI异常率为26.13%;^1HMRS异常率为49.55%,其中双侧异常率为27.27%。发作间期VEEG异常的73例患者中与^1HMRS异常部位完全或基本符合为16例,符合率为21.92%;发作时VEEG异常36例患者中与^1HMRS异常部位完全或基本符合为23例,符合率为63.89%;MRI异常的29例患者中有颞叶病变13例,病变部位^1HMRS均异常,且与脑电图出现的颞叶癫痫波一致;非颞叶病变的患者共16例,其中9例^1HMRS异常;MRI正常的82例患者中有33例^1HMRS异常,且与脑电图出现的颞叶癫痫波一致。结论：MRI颞叶信号异常的出现晚于颞叶代谢异常所致的^1HMRS异常,因此^1HMRS在颞叶癫痫定位诊断方面较MRI更有意义。^1HMRS与VEEG电活动异常呈正相关。临床上应当结合VEEG、MRI等检查结果进行综合分析,以提高致痫灶定位的准确性,为开展外科手术提供强有力的依据。     

25例脑卒中后癫痫发作的临床特点及脑电图特征分析

分析脑卒中后癫痫发作的临床特点及脑电图特征。选取2015年2月~2016年1月就诊于我院的脑卒中后癫痫发作患者25例,分析脑卒中患者癫痫发作临床特点。记录患者癫痫发作的时间、类型和脑卒中后癫痫发作脑电图特征。迟发型癫痫发生率于脑梗死患者中较高,而早发型癫痫发生率于蛛网膜下腔出血和脑出血患者中较高,迟发型癫痫中部分性发作高于早发型癫痫,而早发型癫痫中部分性发作继发全面性发作高于迟发型癫痫(P0.05),迟发型癫痫中全面性发作早发型癫痫中无明显差异(P0.05)。脑卒中后癫痫患者发作期间3例脑电图正常、2例边缘状态脑电图改变;20例脑电图异常,脑电图异常患者中以癫痫样放电为主。脑卒中后癫痫发作的类型及时间具有密切联系,不同类型脑卒中导致癫痫的发生率有明显不同,而脑电图检查多以癫痫样放电为主。因此实施脑电图监测能有效为医师诊断、治疗脑卒中后癫痫发作提供重要的依据。     

晚发性难治性癫癎40例临床分析

目的对40例晚发性难治性癫痫的病因、发作类型、脑电图表现进行分析，明确晚发性难治性癫痫的特点，以指导治疗。方法回顾性分析1994年至2004年癫痫门诊及住院的40例晚发性难治性癫痫患者临床资料，对照组40例为时间及来源相同的晚发性非难活性癫痫患者。通过询问病史、进行实验室检查明确病因，并行脑电监测进行临床分型。结果晚发性难治性癫痫病因明确者占92．5％，晚发性非难治性癫痫的病因明确者占35％，二者比较，差异有显著性（P〈0．005）。晚发性难治性癫痫的脑电图异常率为80％，晚发性非难治性癫痫的脑电图异常率为75％，二者比较差异无显著性（P〉0．05）。两者的发作类型均以部分性发作为主。结论晚发性难治性癫痫病因明确率高于晚发性非难活性癫痫，二者脑电图异常率及发作类型无明显差异。     

91例癫痫儿童临床表现及脑电图分析

目的:分析儿童癫痫的临床及脑电图特征。方法:纳入癫痫儿童91例,收集其临床及脑电图资料,进行回顾性分析。结果:本组患儿平均发病年龄为(4.9±3.0)岁。发作类型中,全面性发作53例(58.2%),局灶性发作38例(41.8%)。明确诊断的癫痫综合征有婴儿痉挛症4例(4.4%),失神发作3例(3.3%),儿童良性癫痫伴中央颞区棘波20例(22.0%)。脑电图异常部位分布中,全头部均有痫样放电者19例(20.9%),痫样放电局限于半球者13例(14.3%)。癫痫儿童发作持续时间5 min者45例(49.5%),5~10 min者33例(36.3%),10 min者13例(14.2%);中颞起源的癫痫患儿中,痫性发作持续时间5及5~10 min者各占37.5%,10 min者25%。结论:儿童癫痫主要集中在4~7岁年龄段,以全面性发作类型为主。脑电图异常部位主要以多灶性起源为主。儿童癫痫发作时间以5 min为主。中颞起源的癫痫儿童出现发作持续时间10 min的可能性较大。     

睡眠脑电监测对临床诊断癫痫的应用价值

[目的]探讨睡眠监测中捕捉异常脑电信息对提高癫痫（EP）临床诊断率的应用价值.[方法]对120例临床诊断疑为癫痫、而经过常规脑电图（REEG）及相关检查不能确诊的患者,采取部分剥夺睡眠后行自然睡眠脑电监测3 h左右,并与入睡前先行的自身常规脑电图记录作对照分析.[结果]120例患者自身REEG异常仅占15%,均呈非特异性异常,睡眠脑电监测异常91.67%,其中特异性异常85.45%,非特性异常14.55%,两者相比差异有显著性（P〈0.01）.[结论]睡眠脑电监测异常信息明显高于REEG,且有很高的特异性,其简便易行,无创伤性,对临床诊断癫痫具有重要的意义.     

毫针蝶骨电极及日间睡眠诱发试验在颞叶癫痫诊断中的应用

目的:探讨蝶骨电极与日间睡眠诱发试验在颞叶癫痫诊断中的应用价值.方法:对62例临床诊断颞叶癫痫的患者依次进行常规头皮电极、蝶骨电极以及日间睡眠诱发脑电图描记,对比分析其结果.结果:常规加蝶骨电极脑电图的癫痫波检出率明显高于常规脑电图(P＜0.01);日间睡眠脑电图的局限性异常率与癫痫波检出率均显著高于常规脑电图(P＜0.01);在睡眠诱发中检出癫痫波的45例患者中,37例癫痫波发生在NREM睡眠Ⅰ～Ⅱ期,占82.2％.结论:脑电图在颞叶癫痫诊断中至关重要,加做蝶骨电极及睡眠诱发脑电图可比常规脑电图提高诊断阳性率.     

脑电图的临床应用——附800例异常脑电图的临床分析

目的探讨脑电图检查的适应证,使脑电图得到更广泛的临床应用。方法对近几年来我科所做的所有中重度异常的脑电图共800例进行回顾分析。结果800例中中度广泛性异常423例,痫样放电190例,重度广泛性异常110例,局灶性异常40例,阵发性节律波16例,电静息16例,高峰矢律5例。病因:癫痫287例,病毒性脑炎及脑系感染202例,外伤88例,脑出血40例,脑梗死32例,头疼27例,头晕14例,病因不明28,其他病因约30多种82例。结论对脑电图敏感常见的病因有癫痫、脑炎、外伤、脑血管病、头痛、头晕,另外还有约30多种病因在对脑功能产生损害时脑电图也有明显反应。     

偏头痛与脑动脉硬化头痛的异常脑电活动比较

偏头痛及脑动脉硬化是神经疾病中常见病 ,两者均以头痛症状为主要表现。为进一步了解偏头痛及脑动脉硬化头痛发作期的异常脑电活动 ,本文对 10 3例偏头痛及 110例脑动脉硬化头痛患者头痛发作期的异常脑电图进行分析、比较。1　资料与方法1.1　一般资料　随机抽取我院 1996～ 1999年门诊有异常脑电图改变的偏头痛患者 10 3例 ,年龄 15～ 46岁 ,男性 3 6例 ,女性67例 ;有异常脑电图改变的脑动脉硬化头痛患者 110例 ,年龄44～ 75岁 ,男性 74例 ,女性 3 6例。1.2　诊断标准　偏头痛诊断标准按国际头痛协会规定诊断标准[1] ,脑动脉硬化诊断标准按…     

磁共振波谱分析对颞叶内侧癫痫患者脑功能定位的监测和评估作用

目的:通过对颞叶癫痫患者的磁共振波谱分析(magneticresonancespec-troscopy,MRS)结果进行分析,探讨其在诊断颞叶内侧癫痫中的作用与意义。方法:经手术治疗的颞叶癫痫患者19例,外侧型5例,内侧型14例,经术中皮质脑电图及手术后病理结果证实;手术前行脑电图、MRI及MRS检查。结果:5例颞叶外侧型癫痫患者海马区MRS检查均无异常,14例颞叶内侧型癫痫患者中6例海马区MRI显示异常,14例MRS检查均显示异常,其中1例显示双侧异常,经硬膜下埋藏电极检查左侧明显。结论:MRS可在MRI出现改变之前发现海马硬化,MRS诊断灵敏且特异性高,是颞叶内侧癫痫诊断治疗、病变功能区域监测及评估的一个可靠方法。     

全身强直-阵挛性发作癫痫的脑电图诊断作用

癫痫是一种常见、病因不清的神经系统疾病,主要特点是脑局部或全脑的异常放电。我国癫痫的终身患病率为0.7%,癫痫的发作类型各异,脑电图（EEG）监测时观察到的脑部放电各不相同。现对脑电图描记资料完整,26例大发作（GTCS）癫痫患者脑电图进行分析。     

Localization of abnormal discharges causing insular epilepsy by magnetoencephalography

The insula, one of the five cerebral lobes of the brain, is located deep within the brain and lies mainly beneath the temporal lobe. Insular epilepsy can be easily confused and misdiagnosed as temporal lobe epilepsy (TLE) because of the similar clinical symptoms and scalp electroencephalography (EEG) findings due to the insula location and neuronal connections with the temporal lobe. Magnetoencephalography (MEG) has higher sensitivity and spatial resolution than scalp EEG, and thus can often identify epileptic discharges not revealed by scalp EEG. Simultaneous scalp EEG and MEG were performed to detect and localize epileptic discharges in two patients known to have insular epilepsy associated with cavernous angioma in the insula. Epileptic discharges were detected as abnormal spikes in the EEG and MEG findings. In Patient 1, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe, similar to TLE. In contrast, the sources of all MEG spikes detected only by MEG (M-spikes) were adjacent to the insular lesion. In Patient 2, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe. These findings indicate that MEG allows us to detect insular activity that is undetectable by scalp EEG. In conclusion, simultaneous EEG and MEG are helpful for detecting spikes and obtaining additional information about the epileptic origin and propagation in patients with insular epilepsy.     

儿童颞叶中内侧硬化所致颞叶癫痫的MRI研究

目的 对儿童颢叶癫痫进行前瞻性MRI研究分析。探讨儿童颢叶癫痫的MRI表现特征。方法 对127例临床和脑电图检查诊断为颢叶癫痫的儿童进行MRI多序列成像．分析研究颞叶的形态结构、信号并判断海马有无萎缩性改变。结果 127例颢叶癫痫患儿中，9例(7．1％)海马有萎缩性改变，且在T2加权成像和液体率减恢复(F1AIR)成像上呈高信号。9例中，6例伴有海马受累同侧颞叶信号异常；3例伴有同侧颞叶皮层结构不良；1例伴有同侧颞叶萎缩。结论 颞叶中内侧硬化是儿童颢叶癫痫的一个相对少见原因，受累侧海马MRI表现为萎缩和信号异常，同时常伴海马外颞叶结构受累。     

脑卒中后癫痫发作的临床研究

目的　研究脑卒中后癫痫发作病人的临床分型及其与原发病和病灶部位的关系,评价脑电图、CT、MRI对癫痫的诊断价值以及治疗的效果。方法　收集门诊、病房几年来治疗的脑卒中合并癫痫发作的病人 68 例,按癫痫发作的时间和临床表现分型。每例病人均做CT、MRI和EEG。结果　本资料中,早期型癫痫22例(32%),迟发型癫痫46例(68%)。癫痫发作类型以额叶癫痫最常见。脑梗死及多发病灶患者占多数。药物治疗控制发作效果较好。脑电图能反映病情变化,病情控制后,脑电图也逐渐好转。而 CT、MRI对病灶的定位不能反映癫痫的类型。结论　额叶癫痫最常见,多发病灶易致癫痫发作。脑电图对癫痫的诊断和判断癫痫的控制有帮助,CT、MRI无助于癫痫的分型和治疗的评价。药物治疗效果较好。     

神经影像导航辅助下的颞叶前部显微切除术治疗顽固性颞叶癫痫

目的：探讨神经影像导航辅助下的颞叶前部显微切除术对顽固性颞叶癫痫的治疗效果。方法：诊断明确的顽固性颞叶癫痫病人18例，术前行脑电图、SPECT及MRI检查，明确病侧颞叶。用StealthStation神经导航系统及术中皮层脑电图，在显微镜下行颞叶前部及海马全切除术。结果：14例术后无发作，脑电图检查未见痫样放电；4例发作次数减少，其中2例脑电图见对侧颞叶痫样放电。术后患者神经功能保持良好，未出现明显后遗症。结论：神经影像导航辅助下的颞叶前部及海马显微切除术是治疗顽固性颞叶癫痫的有效方法；对于诊断明确的颞叶癫痫应尽早手术，以免癫痫频繁发作造成对侧的继发性损伤。     

Combined MEG/EEG analysis of the interictal spike complex in mesial temporal lobe epilepsy

We studied the functional organization of the interictal spike complex in 30 patients with mesial temporal lobe epilepsy (MTLE) using combined magnetoencephalography (MEG)/electroencephalography (EEG) recordings. Spikes could be recorded in 14 patients (47%) during the 2- to 3-h MEG/EEG recording session. The MEG and EEG spikes were subjected to separate dipole analyses; the MEG spike dipole localizations were superimposed on MRI scans. All spike dipoles could be localized to the temporal lobe with a clear preponderance in the medial region. Based on dipole orientations in MEG, patients could be classified into two groups: patients with anterior medial vertical (AMV) dipoles, suggesting epileptic activity in the mediobasal temporal lobe and patients with anterior medial horizontal (AMH) dipoles, indicating involvement of the temporal pole and the anterior parts of the lateral temporal lobe. Whereas patients with AMV dipoles had strictly unitemporal interictal and ictal EEG changes during prolonged video-EEG monitoring, 50% of patients with AMH dipoles showed evidence of bitemporal affection on interictal and ictal EEG. Nine patients underwent epilepsy surgery so far. Whereas all five patients with AMV dipoles became completely seizure-free postoperatively (Class Ia), two out of four patients with AMH dipoles experienced persistent auras (Class Ib). This difference, however, was not statistically significant. We therefore conclude that combined MEG/EEG dipole modeling can identify subcompartments of the temporal lobe involved in epileptic activity and may be helpful to differentiate between subtypes of mesial temporal lobe epilepsy noninvasively.     

颞叶致痫脑肿瘤的MRI影像分析

目的 观察和分析颞叶致痫脑肿瘤患者的临床、肿瘤病理类型和MRI表现.材料与方法 回顾性分析39例颞叶致痫肿瘤的发病年龄、病程与癫痫类型等临床资料、MRI表现、累及部位及病理类型.结果 39例颞叶肿瘤患者的癫痫发病年龄平均9.4岁,36例(92.3％)为儿童期起病;平均癫痫病程98.8个月.以复杂部分性发作居多,共29例(74.4％),其中11例伴全身性强直-震挛发作(GTCS),2例伴失神发作;GTCS和强直性发作分别为5例(12.8％)和2例(5.1％);单纯部分性发作3例(7.7％).颞叶肿瘤病理类型:节细胞胶质瘤24例(61.5％),星形细胞瘤5例(12.8％),少枝胶质细胞瘤和发育不良性神经上皮瘤各3例(7.7％),其他类型肿瘤4例(10.3％).肿瘤位于颢叶内侧和外侧分别为28例和11例;颞叶内侧肿瘤累及海马者(71.4％)显著高于颞叶外侧肿瘤(9.1％).MRI确定病灶为囊实性、实性为主和囊性为主者分别占46.2％、30.8％和23.1％; MRI增强扫描64.1％的病灶无强化.除胚胎发育不良性神经上皮瘤(DNET)位于皮层内,具有多小囊性特征外,其他各类肿瘤MRI表现缺少特异性.结论 颞叶肿瘤性癫痫好发于儿童期,多为累及颞叶内侧或外侧皮层,且为生长缓慢的小肿瘤,其中尤以节细胞胶质瘤居多.癫痫发作类型以复杂部分性发作伴有或不伴有全身强直震挛发作最为常见.     

颞叶癫痫的质子磁共振波谱与PET/CT及术后病理对照研究

目的：对颞叶癫痫患者术前的质子磁共振波谱（1H MRS）与正电子发射断层扫描（PET/CT）、脑电图（EEG）及术后病理进行对照研究，评价1H MRS对颞叶癫痫的诊断价值。方法：16例颞叶癫痫病人，术前均做发作期间脑电图和/或长程脑电图监测及PET/CT检查。对28例健康志愿者和16例患者分别进行双侧海马的1H MRS采集，定量分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和胆碱（Cho）代谢物的变化。3例患者手术切除致痫灶送病检。结果：病侧组、对侧组和对照组的NAA/Cr、Cho/Cr和NAA/（Cho+Cr）值之间的差异均有统计学意义（P<0.05）。16例患者中5例为单侧异常，11例为双侧异常，14例可确定异常侧，定位敏感度87%。结论：患者1H MRS示病侧与EEG、PET和病理改变有较好的对应性，1H MRS不仅可以发现双侧病变，而且可以指出病变严重的一侧，为术前致痫灶的定位提供可靠的依据。     

Characteristics of postictal headache in patients with partial epilepsy

Migraine-like features sometimes characterize the headache that follows epileptic seizure (postictal headache, PIH). We compared patients with different types of epilepsy to investigate the association between migraine-like PIH and seizure type. Subjects comprised 364 patients with partial epilepsy. Epilepsy types were temporal lobe epilepsy (TLE, n = 177), frontal lobe epilepsy (FLE, n = 116), and occipital lobe epilepsy (OLE, n = 71). Patients participated in a structured interview pertaining to PIH as well as interictal headache and family history of migraine. Headaches were classified according to the International Headache Society criteria, which was modified for this study. Forty percent had PIH and 26% of these patients had migraine-like PIH. Migraine-like PIH occurred significantly more often in cases of TLE and OLE than in cases of FLE. In addition, the incidence of interictal migraine headache was significantly higher in patients with migraine-like PIH. These results suggest that migraine-like PIH is related to particular regions of epileptogenic focus and that susceptibility to migraine headache predisposes to migraine-like PIH.     

皮质电极监测在致痫性蛛网膜囊肿手术中的应用

目的探讨术中皮质电极监测在致痫性蛛网膜囊肿手术治疗中的应用价值。方法蛛网膜囊肿病人19例,术前均有癫痫发作史,CT或MRI检查确诊。术前常规脑电图检查正常3例,轻度异常8例,中度异常6例,重度异常2例。常规开颅行蛛网膜囊壁全部或部分切除,同时行皮质电极监测,根据癫痫波位置行致痫灶切除或软膜下横切术。结果 19例病人术中皮质电极均监测到癫痫波,其中12例行致痫灶切除术,4例行多处软膜下横切术,3例行多处软膜下横切并颞极、海马切除术。术后常规脑电图检查均未见癫痫波。随访6个月～4年,18例癫痫消失;1例发作明显减少,口服药物可控制。结论在致痫性蛛网膜囊肿病人手术中,使用皮质电极监测致痫灶,定位准确,灵敏度高。     

Localization of interictal delta and epileptiform EEG activity associated with focal epileptogenic brain lesions

The present study was aimed at investigating the accuracy of electric source reconstruction in the presurgical evaluation of epilepsy patients. Spontaneous EEG activity of 14 patients with focal intracerebral epileptogenic lesions was analyzed by source reconstruction based on high-resolution EEG (64-channel system) and a boundary element method head model accounting for the individual head anatomy. Equivalent dipole modeling was applied to focal delta and interictal epileptiform activity. The localization results were validated quantitatively by comparison with the sites of the structural lesions. In 6 of 9 patients with focal delta activity, the maximum of dipole concentration was closer than 10 mm to the nearest lesion margin and mostly at the border or within pathologically altered cortical tissue. In all 11 patients showing interictal epileptiform activity, the localization results were found in the same lobe as the lesion. In almost half of them, they were closer than 10 mm to the lesion margin. Patients with larger distances (22-36 mm) mostly had hippocampal atrophy or sclerosis. Their dipole locations did not appear in the affected hippocampus, but in the adjacent temporal neocortex. In conclusion, electric source reconstruction applied to both abnormal slow and interictal epileptiform EEG activity seems to be a valuable additional noninvasive component in the multimodal presurgical evaluation of epilepsy patients.