脑磁图和脑电图在癫痫诊治中的应用

目的:观察脑磁图、脑电图和磁共振检查在癫痫诊治中的应用,探讨脑磁图和脑电图的相关性。方法:选择38例经临床诊断的癫痫患者,已进行磁共振检查,并经脑磁图和脑电图发现异常放电。观察三种检查方法的定位符合率,比较影像检查与电生理检查的关系。结果:MEG与EEG定位完全一致的有18例(47．4％),定位基本一致(致少有1个叶定位一致)的有8例(21．1％)。EEG发现双侧放电的13例中,5例与MEG定位基本一致,而EEG单侧局灶放电的25例中,20例与MEG基本一致,EEG与MEG定位符合率在单侧局灶放电患者中高(P＜0．05)。MRI发现结构异常15例,与MEG和EEG定位均一致的有6例。结论:脑磁图和脑电图定位符合率约为68．5％。在单侧局灶放电中, MEG与EEG相结合可使致痫灶定位更加准确。     

高压氧治疗对病毒性脑炎患者EEG改变的研究

目的：探讨高压氧（HBO）治疗病毒性脑炎（病脑）前后的EEG变化。方法：观察HBO治疗病脑32例前后EEG结果,进行对比分析。结果：HBO治疗前EEG异常率为87．5％（28／32例）,HBO治疗后14例EEG恢复正常,10例EEG异常显著改善,4例EEG异常无变化。EEG好转率为85．71％（24／28例）,具有统计学意义（P＜0．01）。结论：HBO是一种治疗病脑的有效方法,EEG检查对病脑的疗效判断及预后分析及重要意义。     

TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中的对比研究

目的探讨彩色经颅多普勒（TCD）、脑电图（EEG）、脑干听觉诱发电位（BAEP）、CT在小儿脑性瘫痪诊断中各自的作用及与临床的关系。方法对2001～2006年采用TCD、EEG、BAEP、CT检查的资料数据完整的40例小儿脑性瘫痪病例,进行统计学处理及分析。结果TCD阳性率为72.5%、EEG为75.0%、BAEP为80.0%、CT为57.5%。TCD、EEG、BAEP之间相比无统计学意义P〉0.05。TCD、EEG、CT亦无统计学意义P〉0.05。仅BAEP阳性率与CT阳性率有统计学意义χ^2=4.1,P〈0.5。结论TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中各自均有一定的价值,对脑性瘫痪的诊断如采用多种检查,将起到相辅相成的作用,综合分析意义更大。     

脑电图监测无CT影像改变的轻型脑伤的临床意义

目的研究脑CT检查为阴性的轻型颅脑损伤的脑电图（EEG）、脑电地形图（BEAM）变化特点及其临床价值。方法对108例轻型颅脑损伤（脑震荡）早期进行动态EEG和BEAM监测。结果无CT影像学改变的轻型脑损伤监测EEG、BEAM有异常改变达88．89％，其中79．17％为异常的0波和8波，伤后3d内测得的阳性显著高于3d后（P〈0．01）。并发现脑生物电异常变化沿受力轴线分布。结论早期反复测定EEG、BEAM变化是反映轻型脑损伤早期脑功能变化定位和伤情分析以及临床诊断治疗效果评判的客观依据。     

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。     

脑囊虫病诊断方法的探讨

为进一步探讨脑囊虫病的诊断方法,对43例具有中枢神经系统症状和体征的病人进行了脑部CT、血清和CSF囊虫抗体检查（ELISA法）,32例CT无典型脑囊虫病改变的患者做了脑MRI检查。结果11例（25．6％）CT表现为多发圆形低密度灶,部分间有点状钙化,为脑囊虫病的典型改变,余32例改变不典型或无异常改变。血清囊虫抗体阳性37例（86．0％）,CSF囊虫抗体阳性32例（74．0％）。27例（84．4％）脑MRI可见典型脑囊虫病改变,5例为非特异性改变。认为脑囊虫病的诊断应结合临床表现、免疫学检查结果和影像学改变综合分析,MRI对脑囊虫病的诊断价值优于CT。     

CT、MRI和EEG对病毒性脑炎的诊断价值

目的探讨CT、MRI和EEG对病毒性脑炎的诊断价值。方法回顾性分析137例病毒性脑炎的临床资料，统计CT、MRI和EEG阳性率检查结果。结果137例全部检测分析。（1）CT的检出阳性率16、8％，MRI为76．4％，EEG为85．12％；（2）MRI与CT比较，两者检出阳性率有显著性差异（x^2=65．56，P〈0.005），EEG与CT比较栓出阳性率有显著性差异（x^2=81．55，P〈0.005）；EEG与MRI比较检出阳性率无差异（x^2=0．34，P〉0．05）。结论MRI和EEG检查对病毒性脑炎的诊断价值较大，病毒性脑炎做CT无多大意义。     

影像学正常的癫(癎)患者的SPECT与长程EEG研究

目的:探讨影像学(CT和MR1)正常的癫(癎)病例的发作间期SPECT与脑电图(EEG)特点.方法:对100例影像学正常病例在发作间期进行SPECT显像、EEG长程监测.结果:共100例中,男57例,女43例.年龄1～54岁.病程平均3.77年.可追溯到病因者63%.全身性发作58%(全身强直阵挛发作52%),局灶性发作42%.发作间期SPECT异常100%,其中低灌注67%,高灌注30%,高-低灌注3%.异常灌注灶156个:脑区151个(97%),其中颞叶76例94个(60%).长程EEG监测正常17%,异常83%,异常者中90%有(癎)样放电.局灶性异常45%和弥漫性异常54%,EEG正常的全身性发作与局灶性发作差异明显(P＜0.01);局灶性异常中全身性发作与局灶性发作比较差异有统计学意义(P＜0.05).结论:影像学正常而发作间期SPECT异常的癫(癎)病例和EEG异常明显增高,全身性发作者各脑区均存在异常灌注灶,其中颞叶异常灌注灶占60.2%.     

婴幼儿病毒性脑炎脑电图与临床相关性研究

目的 探讨婴幼儿病毒性脑炎的临床与脑电图关系.方法 对42例婴幼儿病毒性脑炎患儿的临床资料及脑电图(EEG)、检查情况进行对比分析.结果 EEG异常40例,异常率95.2%,表现为弥漫性慢波增多,有的出现(NFDCC)样放电;脑脊液异常者,EEG均异常.治疗后EEG异常率大为减少(40.5%),两者比较,P＜0.05,差异有统计学意义.EEG异常程度与临床症状有一定的平行关系.结论 EEG改变与临床症状基本一致,与脑脊液异常具有一定相关性.EEG对协助婴幼儿病毒性脑炎的临床诊断及早期诊断、疗效观察,了解脑功能状况、跟踪随访、评估预后具有重要的参考作用.     

儿童热性惊厥脑电图与临床关系分析

目的探讨小儿热性惊厥（FC）脑电图（EEG）与临床的关系。方法记录160例6个月～6岁患儿FC后EEG。结果 EEG异常率为38.1%;EEG异常率与FC临床特征（局灶性发作和FC持续时间〉15min）有关;首次FC的EEG异常率为20.5%,随着FC再发次数的增多逐渐增高。3岁以内FC小儿其EEG异常率不明显,3岁以后的FC小儿EEG的异常率则逐渐增多,有统计学意义;部分患儿多次EEG检查出现发作性棘波,其中3例随访3～4a,最后诊断为癫。结论 EEG异常率与临床特征有关系;FC再发与EEG异常、年龄有明显关系;EEG多次异常FC可发展为癫。     

脑电图对小儿病毒性脑炎诊断和转归的评价

目的探讨病毒性脑炎儿童脑电图异常与病情及预后关系。方法对96例病毒性脑炎的脑电图结果进行回顾性分析。结果脑电图异常率为94.8%。轻型、普通型多表现为弥漫性中波幅或高波幅慢波改变,预后好。重症组以局限性、低波幅慢波多见,预后差。脑电图出现癫样放电者,应警惕继发癫的可能。结论脑电图对小儿病毒性脑炎诊断和转归评估中有较高的价值。     

Concomitant administration of sodium dichloroacetate and thiamine in west syndrome caused by thiamine-responsive pyruvate dehydrogenase complex deficiency

IRDA (intermittent rhythmic delta activity) is an abnormal generalized EEG pattern that is not specific to any single etiology and can occur with diffuse or focal cerebral disturbances. To determine whether different electrographic features of IRDA and associated EEG findings can differentiate underlying focal from diffuse brain disturbances, we performed a blind analysis of 58 consecutive EEGs with an IRDA pattern, recorded from 1993 until 1996, in which we evaluated posterior background activity, focal slowing and IRDA characteristics (frequency, distribution, duration, symmetry and abundance). The clinical diagnosis, state of consciousness and CT brain findings were retrieved from the patients' hospital records. There were 58 patients (33 females; mean age, 58+/-21 years). Twelve (21%) had only focal brain lesions, while 46 (79%) had diffuse brain abnormalities, (15 diffuse structural, 19 metabolic abnormalities, 12 postictal). Normal consciousness and focal EEG slowing were more frequent in patients with focal abnormalities, however, this was not statistically significant. Of the patients with focal abnormality, 11 (92%) had normal posterior background activity either bilaterally (n=4) or contralateral to the focal lesion (n=7). Bilaterally normal posterior background activity was observed in about 30% in both groups. Bilaterally abnormal posterior background activity was apparent in one patient (8%) with focal brain lesion and in 31 patients (67%) with diffuse brain abnormalities (P<0.0001). There were no significant differences in IRDA electrographic features between the focal group and the group with diffuse brain disturbances. We conclude that IRDA morphology cannot distinguish between focal and diffuse brain abnormalities.     

Characteristic early electroencephalographic changes in herpes simplex encephalitis.

We review electroencephalograms taken from 17 patients with severe meningoencephalitis within seven days of onset of CNS symptoms and prior to cortical brain biopsies. All patients had CNS disease clinically compatible with the diagnosis of herpes simplex encephalitis (HSE). The diagnosis was demonstrated by the isolation of virus from the brain in five patients (group 1) but considered highly unlikely in the other 12 patients (group 2) by negative immunofluorescent studies and failure of viral isolation from the brain tissue. Abnormal but nonspecific EEGs with diffuse or focal slowing were found in all patients. Distinctive high-voltage, 1-cycle-per-2-to-3 seconds periodic sharp waves from unilateral temporal lobes were seen only in three of the five patients with virologically proved HSE but in none of the 12 patients without viral isolation. This EEG pattern is strikingly similar in all three patients, regardless of their age, and may be specific for the early diagnosis of HSE prior to brain biopsy. The EEGs of the other two patients with proved HSE did not contain such abnormalities. Athough periodic EEGs with some resemblance to those previously described may occur in other CNS disorders, their presence strongly suggests the diagnosis of HSE when recorded from patients with viral meningoencephalitis. Moreover, EEGs may help locate the best site for cerebral biopsy since maximal yield of the virus in this study was from unilateral temperoal lobes corresponding with the site of local EEG changes.     

EEG findings in tick-borne encephalitis.

EEG findings of epidemiologically and serologically confirmed tick-borne encephalitis patients were compared with findings of patients having acute encephalitis of viral or undetermined origins. Tick-borne encephalitis patients had more bilaterally synchronous bursts of slow waves and more focal abnormalities than did controls. Moreover, their EEGs remained mildly pathological, with increased slow and beta activity and intermittent focal abnormalities in some patients, whereas, EEGs in the controls became normal or borderline, usually within two months. EEG can thus reveal differences between individuals' responses to encephalitis and between different types of encephalitis, even though the clinical pictures are rather similar. Finally, the study shows that tick-borne encephalitis causes changes in the EEG that persist long after the clinical disease appears to have resolved.     

Electroencephalographic analysis of malignant melanoma patients.

EEGs carried out in 202 patients with melanoma were abnormal in 33%. In the absence of systemic or brain metastasis 14% of the patients had abnormal records. If systemic metastases without brain metastasis were present 45% of the patients had abnormal records and with brain metastasis 88% had abnormal EEGs. Only a third of the patients with abnormal records had brain metastasis but metastatic spread to some organ system was present in 76% of those with EEG abnormalities. The diffuse abnormality was less likely to be a "false positive." Ninety-seven percent of the patients with diffuse EEG abnormality had systemic metastasis but 43% of the patients with focal EEG changes had no detected metastasis.     

EEG and neuroimaging localization in partial epilepsy.

We have studied cortical localization provided by surface and sphenoidal electroencephalograms (EEGs) and that of computed tomography (CT), magnetic resonance imaging (MR) and single photon emission tomography (SPECT) in 58 patients with partial epilepsy. Each patient had EEG, MR and SPECT during a hospitalization period of 1-2 weeks. CT scans were obtained either during the same period or had been performed in the preceding year. EEG evaluation consisted of 3-5 days of continuous monitoring including video-telemetry and ambulatory recording as well as conventional EEGs with special electrode placements. Additionally 33 of 58 patients (55%) who were potential surgical candidates had sphenoidal recordings. All patients had an abnormal EEG which showed evidence of epileptic hyperexcitability. EEG abnormality was localized in 43 patients (74%). Neuroimaging studies were focally abnormal in 38 patients (66%); 12 CT (21%), 29 MR (50%) and 24 SPECT (41%). Thirty four of 43 patients with localized EEG had at least 1 focally abnormal neuroimaging study (79%), whereas 4 of 15 (27%) patients with non-localized EEG did so. Twenty-eight of 29 patients with focal MR (97%), 11 of 12 patients with focal CT (92%) and 20 of 24 patients with focal SPECT (83%) had a concordant focal EEG. EEG and neuroimaging localization agreed in all 15 patients in whom both MR and SPECT disclosed a concordant focal abnormality. This study demonstrates a significant (P less than 0.005) correlation between surface/sphenoid EEG and neuroimaging localization in partial epilepsy.     

EEG in neonatal herpes simplex encephalitis

The EEGs of 21 newborns with herpes simplex encephalitis were analysed. The diagnosis was based on the demonstration of herpes simplex infection in association with neurological symptoms, other etiological factors being excluded. Sixteen of 21 babies (76%) showed in their EEGs electrical seizures, either focal or unilateral. These paroxysms consisted of sharp waves or slow waves repeating at pseudo-periodic intervals, usually of 0.5-2 sec. Individual paroxysms had a duration of 10-20 sec in 6 babies and 1-2 min in 10 patients. During the same period, 20 other babies displayed the same EEG finding. Of these, 11 had encephalitis of unknown etiology. In our series there appeared to exist a correlation between both the duration of the electrical seizures and the degree of EEG background abnormality and the clinical outcome. Babies with markedly abnormal background and long-lasting paroxysms tended to have a poor prognosis. It is concluded that in newborns with clinical signs of encephalitis who show in their EEGs paroxysms of the type described, the possibility of herpes simplex encephalitis should be considered.     

The clinical significance of seizures in critically ill young infants requiring intensive care

The aetiology, severity of systemic and biochemical abnormalities, seizure duration, EEGs and CT scans have been reviewed in previously normal young infants with an acute critical illness occurring after the first week of life; none of whom had birth asphyxia. Findings were related to outcome in an attempt to evaluate the significance of seizures during the acute phase of severe illness. In three years seizures occurred in 54/251 (22%) young infants requiring ventilatory support. In these patients the acute illness was most commonly infection and encephalitis/encephalopathy. Twenty-one died, 24 had good or moderate outcome and 9 poor outcome (follow-up 6-27 months). The outcome was not directly related to diagnosis, but to systemic and biochemical changes, the most important being severe hypotension (40/54). After correction of these factors, in survivors, increasing number of days over which seizures occurred during the acute phase of illness was related to worsening outcome (tau(c) = 0.66, p less than 0.0001). In many of these patients one of three abnormal low density changes (generalized, boundary zone and focal) were seen on CT scan and were not uncommonly associated with focal/multifocal clonic seizures and characteristic type, distribution and evolution of EEG discharge. In the 45 patients with EEGs from presentation, severity of encephalopathy assessed by predominant background EEG activity was most closely related to outcome, irrespective of aetiology and seizures. There was a significant relationship between graded severity of background EEG activities and outcome both in the initial and serial recordings (tauB = 0.70, p less than 0.0001 and 0.75, p less than 0.0001 respectively). Seizures are a common occurrence in the previously well young infant with an acute critical illness necessitating intensive care. Prompt recognition and treatment may influence outcome in patients with a potentially reversible encephalopathy. However, in many patients seizures reflect severe, often multifactorial cerebral insult with variable morphological changes, EEG patterns and clinical outcome.     

EEG and pathologic findings in patients undergoing brain biopsy for suspected encephalitis.

Previous studies have suggested that EEG may be helpful in the diagnosis of herpes encephalitis (HE). To further define the value of EEG in an acutely ill, febrile, encephalopathic patient suspected as having encephalitis, we reviewed initial preoperative EEGs with the results of cerebral biopsies in 24 consecutive patients suspected of having encephalitis. Statistical analysis demonstrated that EEG patterns have only limited association with biopsy results. Since diseases which mimic encephalitis may also generate identical EEG changes, this is not an unexpected finding. EEG is useful in the evaluation and management of patients with encephalitis. However, the absence of specific wave forms or focal EEG abnormalities in the proper clinical setting should not deter consideration of HE or delay treatment.