无神经系统定位体征的癲癇大发作患者的EEG和CT分析

目的探讨无神经系统定位体征的癲癇大发作患者的脑电图(EEG)和脑CT变化.方法 68例无神经系统定位体征的癲癇大发作患者作EEG 及脑CT检查.结果 EEG异常率为82.35%,CT异常率为32.35%.CT正常组和异常组中,EEG异常率无明显差异.CT异常率与病程关系不大,但有发病诱因的继发性癲癇CT异常率较无明显原因者显著增高.结论 EEG为癲癇诊断的重要电生理检查方法,且有粗略定位意义,而CT能显示脑结构方面的病理改变,有利于查找病因及病变部位.     

难治性癫痫致病灶术前定位EEG联合fMRI检查的临床研究

目的探讨对难治性癫痫患者术前进行EEG联合fMRI检查确定癫痫致病灶的准确性。方法选取行外科手术的难治性癫痫患者23例为研究对象,患者佩戴能在高场强MR室中使用的EEG高级电极帽,在MR扫描的同时采集EEG数据,记录棘波发生时间,并根据棘波的发放时间输入信号曲线,找出fMRI数据,求fMRI数据体与该曲线的相应关系,将相应程度高的区域(激活区)叠加在MRI的三维图像上,从而对癫痫致病灶进行定位。将该致病灶的位置、范围与手术中脑皮质电极及深部电极中显示的致痫灶进行比较。结果 13例(56.52%)EEG联合fMRI检查显示的癫痫致病灶与术中通过皮质电极及深部电极EEG所描记、确定的致病灶位置和范围完全相同。另外10例(43.48%)EEG联合fMRI检查显示的癫痫致病灶与术中通过皮质电极及深部电极EEG所描记、确定的致病灶位置相同,但是范围明显大于术中所确定的致病灶范围;对患者出院后进行随访6个月以上,其中15例(65.22%)癫痫未再发作,5例(14.29%)术后3周内出现癫痫发作1~4次,给予抗癫痫药物治疗后得到控制,3例(13.04%)仍有发作,给予药物控制后仍无法控制,但发作频率为每月(3.1±1.4)次,较术前发作次数明显降低。结论对难治性癫痫患者术前进行EEG联合fMRI检查定位致病灶,其定位准确,时间及空间分辨率均较高且是无创性的。     

颅脑损伤后癫痫:CT、手术与病理所见

目的：通过外伤后癫痫病人的ＣＴ、手术所见及病理变化的了解，对今后外伤性癫痫病人手术起指导作用。方法：对近１０年来４０例外伤后癫痫病人，再手术所见与ＣＴ、病理变化进行对比。结果：ＣＴ“脑软化”是外伤后癫痫－－脑膜脑瘢痕形成，它与缺血感染引起脑软化不同。结论：外伤性癫痫是顽固性，需外科手术治疗     

动态脑电图在癫痫诊断及鉴别诊断中的价值

目的研究24 h动态脑电图(AEEG)在癫(疒间)的诊断及鉴别诊断中的价值.方法对761例临床拟诊为癫(疒间)及1327例可疑癫(疒间)患者的AEEG资料进行回顾性分析.结果两组AEEG与常规脑电图检查(疒间)样放电检出率比较差异有极显著性(均P＜0.005).230例患者通过AEEG监测证实为癫(疒间)发作.93例患者AEEG监测后发作类型得到了修正.结论 AEEG有助于癫(疒间)的诊断及鉴别诊断.     

Ictal EEG patterns in epilepsy with centro-temporal spikes

Purpose: To describe the EEG pattern of seizures in patients with benign childhood epilepsy with centro-temporal spikes (BCECTS). Methods: The clinical and EEG data of 701 BCECTS patients with at least a 3 years follow-up were reviewed from 10 epilepsy centers. Results: Thirty-four seizures were recorded in 30 patients. Four different ictal EEG patterns (A-D) were identified. The most frequent (pattern A) was characterized by low voltage activity of fast rhythmic spikes, increasing in amplitude and decreasing in frequency, and occurred in 14 children. Pattern B (six patients) was constituted by a discharge of spikes intermixed with sharp waves increasing in frequency and amplitude. Pattern C (seven children) consisted of monomorphic theta which progressively formed a discharge increasing in amplitude and decreasing in frequency. Pattern D (5 children) was characterized by a initial focal depression of the electrical activity, followed by one of the three above described patterns. In 21 out of 28 children, the initial ictal pattern, altered from one pattern to another one. No clinical or EEG feature was predictive of a specific ictal pattern. Discussion: We failed to identify a unique ictal EEG pattern in our patients with BCECTS. The occurrence of per-ictal features, e.g., initial EEG depression or post-ictal slowing, is common and should not be interpreted with prejudice. Alteration of ictal EEG pattern from one to another is not in conflict with the diagnosis of BCECTS.     

Slow repetitive TMS for drug-resistant epilepsy: clinical and EEG findings of a placebo-controlled trial

PURPOSE: To assess the effectiveness of slow repetitive transcranial magnetic stimulation (rTMS) as an adjunctive treatment for drug-resistant epilepsy. METHODS: Forty-three patients with drug-resistant epilepsy from eight Italian Centers underwent a randomized, double-blind, sham-controlled, crossover study on the clinical and EEG effects of slow rTMS. The stimulus frequency was 0.3 Hz. One thousand stimuli per day were given at the resting motor threshold intensity for 5 consecutive days, with a round coil at the vertex. RESULTS: "Active" rTMS was no better than placebo for seizure reduction. However, it decreased interictal EEG epileptiform abnormalities significantly (p < 0.05) in one-third of the patients, which supports a detectable biologic effect. No correlation linked the rTMS effects on seizure frequency to syndrome or anatomic classification, seizure type, EEG changes, or resting motor threshold (an index of motor cortex excitability). CONCLUSIONS: Although the antiepileptic action was not significant (p > 0.05), the individual EEG reactivity to "active" rTMS may be encouraging for the development of more-powerful, noninvasive neuromodulatory strategies.     

睡眠性癫癎患者动态脑电图的研究

目的探讨睡眠性癫疒间患者的24h动态脑电图(AEEG)的表现及其诊断价值。方法对91例仅于睡眠中发作癫疒间的患者进行AEEG检查,并对检查结果进行分析。结果AEEG发现疒间性放电71例(78.0%),其中4例出现于清醒状态,41例出现于睡眠状态,26例清醒和睡眠时均有放电;在67例睡眠时有疒间性放电的患者中,34例仅出现在浅睡期,33例整个睡眠中均出现疒间性放电。清醒时有癫疒间波的患者癫疒间发作频率明显高于无异常放电患者和仅睡眠时有疒间性放电的患者(均P<0.05)。结论睡眠中癫疒间发作患者于睡眠中疒间性放电出现率明显高于白天清醒时。AEEG容易发现睡眠性癫疒间患者的发作期和发作间歇期以及自然睡眠状态下的疒间样波。     

The value of EEG in the investigation of postapoplectic epilepsy

During the 5 years 1979-1983 61 patients within the county of Frederiksberg developed postapoplectic seizures after the age of 60. Of these patients EEG was performed on 48. These EEG's were compared to the EEG's from 25 patients of the same age with epilepsy due to cerebral tumors 33 patients with acute stroke and 24 patients with stroke sequelae who had not experienced seizures. Slow wave activity and foci were seen more often among patients with acute stroke than among patients with postapoplectic seizures whereas paroxysmal activity occurred less often in patients with acute stroke than among patients with postapoplectic seizures patients with stroke sequelae and patients with seizures due to cerebral tumours. Patients with stroke sequelae with proven hemispheric localization had focal abnormalities more often than patients with postapoplectic seizures but apart from this EEG difference between patients with postapoplectic seizures and patients with stroke sequelae or seizures due to brain tumours were not found. In 12 of the patients with postapoplectic seizures and in 20 of the patients with stroke sequelae without seizures EEG at the time of the acute stroke was available. Differences between patients with and patients without seizures were not found neither at the time of the acute stroke nor at the time of readmission due to stroke sequelae or due to onset of seizures. It is concluded that a routine EEG is without value in the diagnosis of postapoplectic seizures in the elderly.     

Juvenile myoclonic epilepsy: clinical and EEG features

We aimed to characterize the clinical profile and EEG features of 43 patients with juvenile myoclonic epilepsy. In a retrospective design we studied the records of, and re-interviewed, 43 patients diagnosed with JME from the epilepsy clinic data base. Furthermore, available EEGs were re-evaluated. Of the patients 72% were female and 28% male. Average age of onset was 13 (5.5–22) years for absences, 16 (5.2–25) years for myoclonic seizures, and 16 (8–29) years for generalized tonic–clonic seizures. Forty-two percent reported asymmetric or unilateral myoclonic jerks. Commonly reported precipitating factors were sleep deprivation (84%), stress (70%), and alcohol consumption (51%). EEG findings included rapid spike-wave and polyspike-wave.     

长程脑电图在癫(癇)诊断与鉴别诊断中的价值

目的探讨长程脑电图(EEG)在癫疒间诊断与鉴别诊断中的价值。方法对265例癫疒间患者(癫疒间组)和206例非癫疒间患者(非癫疒间组)进行长程EEG记录,并进行分析。结果癫疒间组清醒EEG异常率为54.72%,睡眠EEG异常率为89.81%,两者差异有极显著性(P<0.001);非癫疒间组清醒EEG异常率为7.28%,睡眠EEG异常率为10.68%,两者差异无显著性(P>0.05)。癫疒间组患者睡眠时额叶和颞叶的癫疒间性放电阳性率最高,分别为20.38%和24.15%,与清醒状态阳性率(11.32%和11.70%)相比差异有极显著性(均P<0.01)。结论长程EEG在癫疒间的诊断和鉴别诊断中有重要意义,特别是多个周期的睡眠诱导可明显提高癫疒间性放电的阳性率,并对致癫疒间灶的定位提供重要参考。     

EEG changes induced by vigabatrin monotherapy in focal epilepsy

The effect of vigabatrin (GVG) monotherapy on EEG interictal abnormalities and on background activity recorded at rest and during mental tasks was studied in 14 patients suffering from focal epilepsy. A long-term EEG monitoring was performed in each patient before and 3 months after the beginning of GVG therapy. Ictal and interictal EEG abnormalities (IEA) were quantified by specific computer programs. Background activity was evaluated by spectral analysis at rest with eyes closed (EC), during blocking reaction (BR) and during fixation of cartoons (FIX). During treatment, IEA was either decreased or unmodified independently from seizure occurrence, which clearly improved in the majority of patients. The only EEG modifications induced by GVG monotherapy were a more pronounced slowing of the background activity at rest with EC and a reduced responsiveness to BR. EEG data suggest a GVG monotherapy induced mild "sedative" action on attentive tasks rather than on cognitive function.     

EEG features in idiopathic generalized epilepsy: clues to diagnosis

PURPOSE: To investigate the EEG profile and its contribution for diagnosis and management in a group of patients with a clinical diagnosis of idiopathic generalized epilepsy (IGE) who were referred to a tertiary hospital. METHODS: We retrospectively studied clinical and EEG features of 180 consecutive patients with IGE. Eighty patients were diagnosed with juvenile myoclonic epilepsy (JME), 35 had absence epilepsy (AE), 13 had generalized tonic-clonic seizures on awakening (GTCS-A), 28 had generalized tonic-clonic seizures only (TCS), and 24 had adult-onset idiopathic generalized epilepsy (AIGE). The EEGs were classified in typical (synchronous generalized spike or polyspikes-and-wave discharges with normal background), atypical (with clear focalities or asymmetries), and normal. RESULTS: The 493 EEG exams were analyzed. The first EEG was normal in 45% of the 180 patients, and only 33% had typical abnormalities. AE had a higher proportion of typical examinations and needed fewer sequential examinations to register a typical abnormality compared with the other groups. By contrast, the serial EEG profile of TCS and AIGE showed a higher proportion of normal and atypical EEG findings. CONCLUSIONS: These findings support previous recommendations that IGE patients should be treated with appropriate therapy based on clinical history. Waiting for a typical abnormal EEG pattern can generate an unacceptable delay in the correct diagnosis and treatment of these patients. In patients with long-term epilepsy, the diagnosis may be difficult. Furthermore, serial EEGs can help to elucidate the syndromic diagnosis, especially in patients with TCS and AIGE.     

Correlation between quantitative EEG and MRI in idiopathic generalized epilepsy

The objective of this study was to investigate the relationship between the focal discharges sometimes observed in the electroencephalogram of patients with idiopathic generalized epilepsies and subtle structural magnetic resonance imaging abnormalities. The main hypothesis to be assessed is that focal discharges may arise from areas of structural abnormality which can be detected by quantitative neuroimaging. Focal discharges were used for quantitative electroencephalogram source detection. Neuroimaging investigations consisted of voxel‐based morphometry and region of interest volumetry. For voxel‐based morphometry, volumetric MRI were acquired and processed. The images of each patient were individually compared with a control group. Statistical analysis was used to detect differences in gray matter volumes. Region of interest‐based morphometry was automatically performed and used essentially to confirm voxel‐based morphometry findings. The localization of the focal discharges on the electroencephalogram was compared to the neuroimaging results. Twenty‐two patients with idiopathic generalized epilepsies were evaluated. Gray matter abnormalities were detected by voxel‐based morphometry analysis in 77% of the patients. There was a good concordance between EEG source detection and voxel‐based morphometry. On average, the nearest voxels detected by these methods were 19 mm (mm) apart and the most statistically significant voxels were 34 mm apart. This study suggests that in some cases subtle gray matter abnormalities are associated with focal epileptiform discharges observed in the electroencephalograms of patients with idiopathic generalized epilepsies. Hum Brain Mapp, 2010. © 2010 Wiley‐Liss, Inc.     

Lorazepam: Its effect on the EEG paroxysmal activity in patients with epilepsy

Benzodiazepines given intravenously abort status epilepticus, and abolish paroxysmal EEG discharges. The study reported concerns the effect of small doses (about 1 mg) of lorazepam on these EEG changes, assessed visually, in the resting record, as well as during overbreathing and photic stimulation. Thirty patients were examined, approximately half had primary generalised and the remainder focal epilepsy. All showed rapid reduction of paroxysms in the first few minutes following injection. This occurred faster and was much more persistent for the generalised than for the focal group. The effect of chronic oral administration of lorazepam in these patients is under investigation.     

癫(痫)患者脑磁共振表现与脑电图异常的相关性

目的:探讨癫(痫)患者脑电图(EEG)异常部位与脑磁共振(MRI)异常部位的相关性.方法:收集2015年1月～2016年8月在南京脑科医院住院的290例癫(痫)患者的EEG及MRI结果进行回顾性分析.结果:EEG癫(痫)波检出率在MRI异常组为98.5％,显著高于MRI正常组(79.5％)(P＜0.05).耐药性癫(痫)的发生率在MRI异常组(26.1％)显著高于MRI正常组(10.3％)(P＜0.05).MRI异常部位与EEG异常部位的重合率在海马硬化组(95％)和脑发育不良组(84.6％)显著高于其它各组.耐药性癫(痫)的发生率在脑发育不良组(50％)及海马硬化组(30％)高于其他各组.结论:癫(痫)患者在MRI上显示海马硬化及脑发育不良时,其作为癫(痫)病灶存在的可能性极大,且耐药性癫(痫)的发生率高.     

Intracranial EEG seizure-onset patterns in neocortical epilepsy

PURPOSE: We investigated neocortical seizure-onset patterns recorded by intracranial EEG with regard to anatomic location, pathologic substrate, and prognostic value for surgical outcome. METHODS: Seizure onset was analyzed in 53 neocortical resective epilepsy surgery patients. Anatomic location was divided into temporal and extratemporal. Pathologic substrate was classified as developmental, mature, and negative or non-specific gliosis. Onset frequency was categorized by visual analysis into tradition EEG frequency bands. Spatial extent was divided into focal (fewer than four contacts) and regional (more than five contacts). Waveform at seizure onset was divided into several types based on their morphology. Onset features were examined with respect to anatomic location, pathologic substrate, and surgical outcome. RESULTS: Seizure-onset frequency was significantly related to spatial distribution and to anatomic location. Extratemporal and regional onset were more commonly in the gamma range, and temporal and focal onset in the beta frequency range or slower. Waveform could be categorized into five different patterns, of which low voltage fast activity (LVFA) was the most common form (57%). LVFA and rhythmic alpha-theta spike activity were more common in developmental than in mature pathology, whereas rhythmic sinusoidal waves at onset were found in only mature substrates. Waveform pattern showed a possible correlation with surgical outcome (p = 0.097): LVFA and rhythmic sinusoidal waves onset patterns were associated with favorable outcome more often (40.4%) than the other three patterns (6.3%). Slow onset suggested poor outcome in the subgroup of developmental pathology (p = 0.062). CONCLUSIONS: Certain electrographic seizure-onset features are associated with specific substrates and outcomes, whereas others reflect the anatomic location and its connections independent of the pathology.     

EEG findings in minor head trauma as a clue for indication to CT scan

In order to investigate the role of EEG in minor head traumata in the pediatric age, EEG and CT scan findings were compared in a series of 103 consecutive cases of children hospitalized within 24 h after head trauma. The EEGs were classified as normal in 50 patients, borderline in 10 patients, and abnormal in 43 patients. CT scan showed contusion in 6 patients and extracerebral hematoma in 4. All cases of abnormal CT scans were reported for patients with frankly abnormal EEG findings. In contrast, no pathological findings were found in CT scans for patients with normal EEG. The data suggest that EEG findings can play a major role in the diagnostic workup of patients with minor head traumata. Specifically, in the case of asymptomatic patients with normal EEG findings, it is likely that the CT scan will also be normal.Presented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

The clinical usefulness of ictal surface EEG in neocortical epilepsy

PURPOSE: Localizable scalp EEGs, during ictal episodes, appear to be rare in neocortical epileptic syndromes. However, studies based on large numbers of patients are also rare. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic focuses. METHODS: We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded using a video-EEG monitoring system with electrodes placed according to the International 10-20 system, with additional anterior temporal electrodes. The ictal recordings were analyzed according to localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. RESULTS: The percentage of discrete or regional EEGs was 23% in frontal lobe epilepsy, 52% in lateral temporal lobe epilepsy, 70% in occipital lobe epilepsy, and 10% in parietal lobe epilepsy. In order of frequency, the localizable ictal rhythms were theta, beta, alpha, delta, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms was significantly shorter in frontal lobe epilepsy and parietal lobe epilepsy than in other epilepsies. Ictal beta activity was the most common rhythm in discrete-patterned EEGs. Structural lesions found on MRI did not significantly affect the localization of epileptogenic focuses in the patients. The type of seizure was not related to the degree of localization, with the exception of simple partial seizure. CONCLUSIONS: Ictal surface EEG was clinically helpful in the localization of epileptogenic focuses in at least some neocortical epileptic syndromes.