动态脑电图对癫痫诊断和临别诊断的意义

对临床诊断癫痫的５３例和可疑癫痫的１１７例进行２４ｈ动态脑电图监 。结果ＫＡＥＥＧ阳性率明显高于常规ＥＥＧ，ＡＥＥＧ痫样放电率在癫痫组为５４．７％，可疑癫痫组为１５．４％。本文对痫样放电出现与临床发作间的关系以及痫痫诊断和鉴别诊断进行了讨论。     

民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２４小时脑电／心电同步监测对癫痫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例临床怀疑癫痫性晕厥和心律失常性晕厥患者进行２４小时动态脑电图（ＡＥＥＧ）／心电图（ＥＥＧ）同步监测。结果：（１）癫痫性晕厥４２例中,ＥＥＧ总异常率８３．９１％。痫样放电出现率７１．２４％;心电图显著异常率１９％;（２）心律失常性晕厥２１例中,ＥＥＧ总异常率２４％,痫样放电出现率５％,心电衅显著异常９１％;（３）可疑癫痫性晕厥４例中,ＡＥＥＧ痫样放电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（癫痫与民律失常两种疾病并存）２例,均检出痫样放电及显著心律失常。结论：２４小时ＥＣＧ同步监测对癫痫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。     

电视-脑电长时间监测对癫痫诊断的临床意义

目的研究电视脑电（ＶｉｄｅｏＥＥＧ）长时间监测在癫痫诊断中的意义。方法对临床上１２４例诊断为癫痫、９２例可疑癫痫及３３例非癫痫患者行ＶｉｄｅｏＥＥＧ监测,并与临床诊断的结果进行对比。结果临床诊断为癫痫组患者中８４７％（１０５／１２４）记录到临床发作,原诊断为强直阵挛性发作（ＧＴＣＳ）中有１０例经ＶｉｄｅｏＥＥＧ监测确认为复杂部分性发作（ＣＰＳ）;９２例可疑癫痫患者中２４％（２２／９２）被确认为癫痫。可疑“头痛型癫痫“、“腹痛型癫痫”的４０例患者中,仅有１例其头痛与发作密切相关。另有６例有ＣＰＳ发作,但头痛或腹痛并非癫痫发作表现。结论ＶｉｄｅｏＥＥＧ对癫痫的诊断、鉴别及分类有重要意义。     

日间睡眠脑电图在癫痫诊断中的应用

目的：探讨睡眠脑电图（ＥＥＧ）在癫痫诊断中的价值及适应症。方法：过去１０年间５２２例患有癫痫及各种发作性疾患病人的睡眠及清醒ＥＥＧ进行研究。结果：ＥＥＧ有异常爆发活动（ＰＡ）者２１７例，ＰＡ只在睡眠中出现者９６例，痫样放电的检出率由清醒的２３．２％提高到４１．６％。１５例病人通过发作间期或发作期的睡眠ＥＥＧ显示的ＰＡ，进一步明确癫痫发作类型。在９７例有中央－－颞棘波的儿童良性部分性癫痫中，５０例（     

发作期及发作间期痫性放电对癫痫的诊断价值

目的：探讨发作期及发作间期脑电图对癫痫诊断的意义。方法：对５６例癫痫患者常规脑电图（ＲＥＥＧ）与２４ｈ脑电图（ＡＥＥＧ）进行比较研究。结果（１）ＲＥＥＧ阳性率为３０％，而ＡＥＥＧ的阳性率为８６％；（２）不同类型癫痫在发作期和发作间期大脑活动的规律和特点，ＲＥＥＧ无１例记录到癫痫发作，而ＡＥＥＧ有２７例（４８％）记录到癫痫发作安全过程的大脑电活动变化，结论发作期的ＥＥＧ对确定癫痫类型有重要意义，全身     

151例儿童发作性疾病的24h动态脑电图监测

目的 对儿童发作性疾病的脑电活动进行分析。方法 对１５１例发作性疾病儿童应用２４ｈ便携式磁带记录脑电图（ＡＥＥＧ）进行监测。结果 总异常率８０．８％，痫样放电出现率７９．５％。癫痫组痫样放电出现率７８．８％，可疑癫痫组痫样放电出现率４５．５％，两组之间有非常显著差异（Ｐ〈０．００５）。ＡＥＥＧ痫样放电出现率明显高于常规脑电图（ＥＥＧ）；癫痫组与可疑癫痫组之间临床发作中所描记到的痫样放电出现率明显高     

发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

目的：探讨发作间期１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射断层扫描（ＰＥＴ）和９９ｍＴｃ－己撑半脱氨酸（ＥＣＤ）单光子发射断层扫描对顽固性颞叶癫痫（ＴＬＥ）的定位诊断价值。方法：５３例脑电图（ＥＥＧ）定位明确的顽固性ＴＬＥ患者分别行发作间期１８Ｆ－ＦＤＧＰＥＴ和９９ｍＴｃ－ＥＣＤＳＰＥＣＴ检查。其中２１例磁共振（ＭＲＩ）显示有结构性病变并与ＥＥＧ定位结果一致。结果：ＭＲＩ异常组均在ＰＥＴ和ＳＰＥＣＴ相应部位出现低代谢和低灌注表现。ＭＲＩ正常组，ＰＥＴ定位准确性为８４．５％，显著高于ＳＰＥＣＴ的５６．３％（Ｐ＜０．０５）。结论：对于无结构性病变的颞叶癫痫，发作间期ＰＥＴ检查有较高的定位诊断价值，ＳＰＥＣＴ的临床意义相对较小     

录像脑电图在儿童癫痫诊断中的价值

目的 探讨提高儿童癫痫确诊率的方法和录像脑电图在儿童癫痫诊断中的价值。方法 对８４例儿童癫痫患者进行２４小时录像脑电图（ＶＥＧ）描记,并和常规脑电图（ＥＥＧ）对比分析。结果 ＶＥＥＧ阳性率为８６．９％,临床发作率３９．３％;明显高于常规ＥＥＧ阳性率为４０．５％,临床发作率２．４％（均Ｐ〈０．０１）。结论 ＶＥＥＧ在儿童癫痫的诊断、分类、术前评估等方面较常规ＥＥＧ更有价值。     

动态脑电图对32例晕厥患者的监测分析

目的：观察动态脑电图（ＡＥＥＧ）对晕厥患者监测的阳性率,并与常规脑电图（ＥＥＧ）、ＣＴ进行对照观察。方法：应用ＡＥＥＧ、ＥＥＧ和ＣＴ对晕厥患者进行检查。结果：３２例晕厥患者ＡＥＥＧ监测结果,１６例异常,阳性率为５０％,ＥＥＧ异常３例,阳性率为１１．５％;头ＣＴ检查２例异常,阳性率为６．３％。结论：ＡＥＥＧ对晕厥监测阳性率明显高于ＥＥＧ及ＣＴ。对晕厥患者中不典型及睡觉中亚临床癫痫发作提供了诊断与鉴别诊断依据。     

24h动态脑电图对癫痫的诊断意义

目的：了解动态脑电图对癫痫诊断的应用价值。方法：对１１２名诊断癫痫，可疑癫痫及发作性晕厥病人行２４ｈ动态脑电图检查，并在一周内做脑电图或脑电地形图检查作为自身对照，结果：发现全部病人组ＡＥＥＧ痫放样电检出率明显高于ＥＥＧ／ＢＥＡＭ组，在癫痫发作类型中，以复杂部分性发作ＡＥＥＧ痫样放电阳性率明显高于ＥＥＧ／ＢＥＡＭ组，睡眠期痫样放电检出占有痫样放电患者５６／６７（８４％），主要出现在ＮＲＥＭ－Ⅱ期（     

Patients with coexistent psychogenic pseudoepileptic and epileptic seizures: a psychological profile

Despite significant advances in epileptology, the differential diagnosis of epileptic and pseudoepileptic seizures continues to be a considerable challenge. The problem becomes even more complicated when epileptic and psychogenic pseudoepileptic seizures coexist in the same patient. Appropriate psychological measures may be helpful in the diagnosis and may improve knowledge about aetiological factors which can provoke psychogenic pseudoepileptic seizures. The purpose of this paper is to present the psychological profile of patients with mixed seizures (epileptic and psychogenic pseudoepileptic) developed on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) and to discuss the personality differences between patients with psychogenic epileptic seizures and epileptic patients. In patients with diagnosed epilepsy and/or suspected psychogenic pseudoepileptic seizures long-term video-monitoring was performed. On the basis of the gathered data the patients were divided into three groups: group I (N= 32 : 25 F and 7 M) had coexistent psychogenic pseudoepileptic and epileptic seizures, group II (N= 38 : 30 F and 8 M) had psychogenic pseudoepileptic seizures only and group III (N= 36 : 18 F and 8 M) had epileptic seizures only and was treated as the control group. All three groups were given the MMPI. Comparison of the averaged personality profiles of the three groups revealed significant differences (P< 0.0001) in hypochondriasis (Hs) and hysteria (Hy), similarity of the profiles of groups I and II, and significantly higher Hs and Hy scores than D (Depression) scores (P< 0.001). Unlike groups I and II, group III (the epileptic group) had significantly higher D scores than Hs and Hy scores (P< 0.01). Our findings suggest that conversion, manifested in the typically elevated Hs and Hy scores as compared to D scores, is present in both groups of patients demonstrating pseudoepileptic seizures but absent in the patients with epilepsy where the Hs and Hy to D ratio is reversed. Patients with mixed seizures and patients with psychogenic pseudoepileptic seizures only have similarly shaped profiles.     

动态脑电图对癫痫的诊断价值

目的探讨动态脑电图(ambulatory electroencephalogram,AEEG)对癫痫(epilepsy,EP)的诊断价值。方法应用奥地利EMS16道脑电记录仪对54例临床诊断为癫痫(常规脑电图均未发现痫样放电)的患者,进行动态脑电图监测。结果①经AEEG检查有痫样放电者44例,阳性率81.5%;②有临床发作者37例(68.5%),其中30例(55.6%)同时出现痫性放电;3例(5.6%)发作期无痫样放电,发作间期脑电图显示痫样放电;4例(7.4%)发作期和发作间期均没有痫样放电;③17例(31.5%)未监测到临床发作,其中11例(20.3%)有痫样放电;6例(1.1%)无痫样放电。结论AEEG监测对癫痫的诊断具有重要价值。     

Profiles of instant heart rate during partial seizures

Instant heart rate (R-R intervals) can be readily studied during spontaneous seizures recorded with ambulatory cassette AEEG/AECG techniques. Ninety-three seizures were recorded in 32 patients with complex partial epilepsy. Instant R-R interval plots showed that 74% of seizures were associated with a dominant tachycardia, the most characteristic features of which were the initial steep acceleration phase at seizure onset and the wide fluctuations in heart rate ('exaggerated sinus arrhythmia') which occurred during and immediately after the seizure. Five percent of seizures were associated with a dominant but transient phase of heart rate slowing during or towards the end of the seizure. Nineteen percent of seizures showed equivocal or negative ictal effects on the heart rate and rhythm despite unequivocal AEEG seizure discharges. Conversely, other patients had characteristic heart rate changes despite equivocal AEEG abnormality. The heart rate profiles showed striking seizure-to-seizure similarities when multiple fits were recorded in the same patient. Ratemeter profiles may be clinically useful to locate epileptic seizures in long duration records; they can help to locate seizures which are either inaccurately timed or poorly identified by the event marker, or not clearly associated with definite AEEG changes. The secondary cardiac effects of epilepsy may be misdiagnosed if their primary cerebral origin is not suspected.     

动态脑电图对癫痫诊断和鉴别诊断的探讨

目的：了解动态脑电图对癫痫诊断和鉴别诊断的意义。方法：用MB8000型8导激光动态脑电图记录仪对145例诊断为癫痫,可疑癫痫病人进行24h动态脑电图检查。结果：总异常率为524％,癫痫组异常62．4％,癫痫样放电出现率58．1％。可疑癫痫组异常34．6％,痫样放电出现率25.0%,两级之间有非常显著性差异（P＜0.001）。癫痫组与可疑癫痫组临床发作中所描记到的痫样放电出现率亦有非常显著性差异（P＜0.001）。痫样放电时间以睡眠期为主,占83、3%。结论：本文着重分析讨论了动态脑电图睡眠期的意义及对伪迹鉴别的体会,24h脑电图对癫痫的诊断和鉴别诊断明显优于常规脑电图,有着重要的临床意义。     

100例癫痫患者脑电图与磁共振分析

目的:观察脑电图和头颅MRI在确诊癫痫及其病因诊治方面的应用,探讨痫性放电与结构异常之间的关系。方法:选100例癫痫患者,均作REEG、AEEG、头颅CT和MRI检查。比较四种检查方法的阳性率和异常病灶的分布。应用卡方检验,比较痫性放电与结构异常之间的关系。结果;REEG痫性放电35例(35%),AEEG76例(76%),比REEG多提供了41%的异常信息。CT发现颅内异常25例(25%),MRI发现异常58例(58%)。在EEG单侧局灶放电的53例中,MRI异常42例,18例双侧半球放电中,MRI异常5例,经x2检验,局灶痫性放电者MRI异常率显著高于双侧半球痫性放电者(P<0.01);MRI正常的42例患者中EEG痫性放电26例,异常率为61.9%,MRI发现结构异常的58例患者中,EEG异常放电50例,异常率为86.2%,经x2检验发现MRI结构异常患者,痫性放电出现率高(P<0.01)。结沦:AEEG是确诊癫痫、指导治疗的有利依据;MRI可作为癫痫患者病因诊断的首选影像检查。痫性放电与结构异常有一定关系。     

300例癫痫及可疑癫痫患者AEEG分析

目的：对３００例癫痫及可疑癫痫患者的动态脑电图的应用价值进行了初步探讨。方法;使用北京明思公司ＳＷ－ＪＨ系列智能化脑电监护仪描记,并与常规脑电图比较。结果：３００例中ＥＥＧ异常５４例,ＡＥＥＧ异常１７８例ＡＥＥＧ痫样放电检出率明显高天ＥＥＧ。１４４例继发性癫痫患者中,ＥＥＧ异常８例,ＡＥＥＧ异常１０例,二者无显著性差异。     

Success of ambulatory EEG in children.

SUMMARY: Continuous ambulatory EEG (AEEG) monitoring is a method used to (1) determine seizure type and location of seizure onset, and (2) to discriminate between epileptic and nonepileptic events. This study was performed to determine how successful AEEG would be in recording seizures when the events were reported to occur at least 3 days per week. AEEGs of children who were patients at Children's Hospital Oakland between December 1993 and June 1997 were reviewed to see why the recordings were performed and to determine whether typical seizures were recorded. Children who had seizurelike events needed to have typical spells 3 days or more per week to justify obtaining AEEG. Most AEEGs were performed to discriminate between epileptic and nonepileptic seizures. A total of 167 children underwent AEEG recording. Ten were recorded to determine whether they were having frequent subtle seizures or frequent interictal epileptiform discharges. The remaining 157 patients had discrete events. A total of 140 children (89%) had their typical spells recorded. A total of 107 of these children (76%) had nonepileptic events. Average duration of recording was 1.9 days. AEEG is very successful in recording children's seizurelike events when parents report events occur at least 3 days per week. The procedure is well tolerated and there are few technical problems that prolong recording time.     

Postictal symptoms help distinguish patients with epileptic seizures from those with non-epileptic seizures.

The aim of the study was to assess whether post-ictal symptoms can help distinguish patients who have epileptic seizures from those with non-epileptic seizures (NES). We reviewed the spontaneous responses to the question 'What symptoms do you have after a seizure?' in 16 patients with epileptic seizures (predominantly focal with secondary generalization or generalized tonic-clonic) and 23 NES patients. Six of the 16 patients (38%) vs. only one of 23 NES patients (4.3%) noted post-ictal headache (P = 0.008). Nine epilepsy patients (56%) vs. three NES patients (13%) reported post-ictal fatigue (P = 0.004). Confusion or other symptoms did not distinguish epilepsy patients from those with NES. All epilepsy patients had at least one post-ictal symptom while 12 NES patients (52%) had none (P = 0.001). Therefore, patients evaluated for epileptic vs. non-epileptic seizures who have post-ictal fatigue or headache, are more likely to have epileptic seizures. Patients with a diagnosis of NES who note post-ictal fatigue or headache should be investigated further.     

The value of provocation methods in patients suspected of having non-epileptic seizures.

Non-epileptic seizures (NES) are reported in 18-23% of patients referred to comprehensive epilepsy centres. Non-epileptic seizures may also be present in 5-20% of the patients who are diagnosed as having refractory seizures. Because of their prevalence, financial and psychosocial outcomes cannot be ignored and accurate diagnosis is of the utmost importance. Various methods of seizure induction have been developed with the aim of differentiating epileptic from non-epileptic seizures. However, recording the attacks by video-EEG monitoring is the gold standard. In our outpatient EEG laboratory we try to induce seizures with verbal suggestion or IV saline infusion in patients who are referred by a clinician with the diagnosis of probable non-epileptic seizures. In this study we investigated the results of 72 patients who were referred between January 1992-June 1996. Non-epileptic seizures were observed in 52 (72.2%) patients. Thirteen of these patients still had risk factors for epilepsy. We could not decide whether all of their previous attacks were non-epileptic because 10-30% of the patients with NES also have epileptic seizures. For a more accurate diagnosis it was decided that these 13 patients, together with the 20 patients who did not have seizures with induction, needed video-EEG monitoring. Thirty-nine patients who had NES and no risk factors for epilepsy were thought to have pure non-epileptic seizures. We claim that not all patients suspected of having NES need long-term video-EEG monitoring and almost half (54.2%) of the cases can be eliminated by seizure induction with some provocative techniques.     

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。