PLED pattern and its clinical significance in stroke patients

The pathophysiological connection between periodic lateralized epileptiform discharges (PLED) and epileptic seizures is still not clear. In the study clinical data and EEG findings were analysed in 22 patients aged 43-90 years with a history of stroke in whom EEG disclosed PLED. Eleven patients were studied in the acute phase of stroke and 11 were studied years after stroke when the diagnosis was established of poststroke epilepsy. In 2 patients in acute stroke group single epileptic seizures occurred and 5 had partial status epilepticus. In the group with poststroke epilepsy 4 had single seizures and 4 had epileptic status with partial epilepsy seizures. Thus, in 15 out of 22 patients PLEDs were noted after epileptic seizures. In all cases PLED appearance was connected with consciousness disturbances, lasting 1 to 17 days. In 6 cases PLED pattern was interrupted by seizure activity over one hemisphere, in 3 of them partial epileptic seizures were associated with it. In acute phase of stroke neuroimaging demonstrated the presence of fresh ischaemic foci, but in cases of poststroke epilepsy no such fresh foci were observed. These results suggest that PLED frequently can be associated with epilepsy, and in some patients it can be a bioelectrical manifestation of partial status epileptic.     

联合应用电生理技术对癫痫灶精确定位的研究

目的:联合应用多种电生理技术(EEG)对痫灶进行定位。方法:运用多种EEG技术对50例癫痫患者行痫灶定位,并与各种神经影像学检查方法进行比较。定位明确患者行手术治疗,标本行光镜及透射电镜检查,治疗结果以Engel疗效分级评价。结果:使用EEG技术对痫灶定位,其准确率为83.3％,以EEG技术为基础,并与神经影像学方法联合应用,痫灶定位准确率则达到100％。具有EEG异常的癫痫患者,痫灶必然伴有相应病理性损害。结论:反复、多次视频脑电(VEEG)监测,是痫灶定位的首选方法。多种类型的EEG在不同的时段进行监测,是高效、经济、安全无创,可明显提高癫痫灶的检出率及定位的准确性,提高手术疗效。     

140例癫痫之CT规范化脑电图比较分析

目的:探讨CT和规范化脑电图对癫痫的诊断意义,探讨脑部结构异常与痫性放电之间的关系。方法:对140例癫痫患者的病史、脑CT和规范化脑电图资料进行回顾性分析。结果:癫痫患者脑CT和规范化脑电图异常率分别为38.57%、82.86%。隐原性癫痫92例,CT异常27.17%,规范化脑电图异常79.35%%。症状性癫痫48例,CT异常60.42%,规范化脑电图异常89.58%。CT异常组中规范化脑电图异常77.78%,CT正常组中规范化脑电图异常86.05%。结论:脑CT和规范化脑电图对于诊断癫痫皆具重要价值,脑CT在癫痫病因寻找中起重要作用,规范化脑电图对癫痫分型具有重要意义,脑部结构异常与痫性放电的阳性率关系不明显。     

发作间期颞叶癫痫的18F-FDG PET 显像研究

目的：采用诊断试验评价方法评估发作间期^18F-FDG PET显像对颞叶癫痫定性和病业定位的诊断价值，探讨其外科治疗的意义。方法：26例CT或MRI检查正常，经临床及脑电图诊断的颞叶癫痫患者在同期进行发作间期^18F-FDG PET脑显像，图像通过目测和半定量的方法进行分析，PET显示的低代谢区行皮层脑电图（EcoG）或深部脑电图（DEEG）描记以评估^18F-FDG PET检测癫痫灶的特异性，17例定位明确的单侧颞叶癫痫行前颞叶切除术，术手进行随访。2例PET未检出癫痫灶，7例DEEG定位双侧病灶未行手术治疗。结果：26例颞叶癫痫中，发现^18F-FDG PET对癫痫灶检出的灵敏度为92%（24/26），特异度为87%(21/24)。结论：从颞叶癫痫的定性定位诊断来看，发作间期^18F-FDG PET脑显像对癫痫灶的检出率较高，但^18F-FDG PET显示的低代谢区与癫痫灶的位置并非完全重叠，尚需要其他的诊断措施加以肯定，^18F-FDG PET和皮层脑电图或深部脑电图对癫痫病灶定位的一致性是手术成功的关键。     

Multiple sclerosis and epilepsy. An analysis of 14 case histories

Fourteen of 330 patients with the clinical and laboratory supported definite diagnosis of Multiple Sklerose (MS) had epileptic seizures. The epilepsy of six patients probably originates from the MS. Four patients respectively suffered from genuin epilepsy or symptomatic epilepsy caused by other diseases than the MS. Most patients had GM, two GM and focal motor fits and one uncinatus fits. An epileptic focus in the EEG was evident in two patients. MRI- and CCT-scans frequently showed extensive cortex-neighboured lesions and multiple subcortical demyelination, especially localized in the temporal lobe. Epileptic seizures as a symptom of MS are very seldom. The longer the interval from the first episode of the MS to the first epileptic seizure the more probable epilepsy is caused by other reasons than the MS.     

卒中后继发癫痫患者常规与动态脑电图检查的比较分析

目的研究卒中后继发癫痫患者常规脑电图(electroencephalography,EEG)与动态脑电图(ambulatory electroencephalography,AEEG)的特点。方法观察40例急性卒中后继发癫痫患者的病灶分布、范围、癫痫发作形式及频数,所有病例作EEG及AEEG检查,将检查结果分为正常、轻度异常、中度异常及重度异常进行统计分析。结果40例研究对象的病灶分布主要在颞叶、额叶及丘脑,癫痫发作类型主要为全面性强直阵挛发作。EEG检查异常的比率为47.5%,其中轻度异常占异常总数的52.6%,中度和重度异常占47.4%;AEEG检查异常的比率为80%,其中轻度异常占异常总数的12.5%,中度和重度异常占87.5%,AEEG较EEG检查的异常比率明显增高,具有统计学差异。结论AEEG可显著提高卒中后癫痫发作患者的脑电异常检出率,其检查结果对指导临床治疗具有一定的价值。     

长程视频脑电监测对癫痫间的诊断价值

目的 评价长程视频脑电图对癫痫间等发作性疾病的诊断价值,提高癫痫间及癫痫间综合征的诊断。方法 对在本院神经内科癫痫间中心门诊及住院患者中首次以发作性疾病就诊的患者进行不同时程的视频脑电图监测,对其临床资料进行回顾性分析。结果 24 h组视频脑电监测对癫痫间异常脑波放电的阳性检出率较高(76.9%),8 h组最低(30.1%),15 h组介于两者之间(55.4%),在24 h组1920例患者中有1476例有异常放电,287例记录到临床同步发作,其中153例明确癫痫间发作类型,153例中96例进一步明确为癫痫间综合征,使对癫痫间的分型及癫痫间综合征的分类更加明了细化。结论 24 h视频脑电监测能够显著提高癫痫间患者的诊断率及异常脑波的检出率,有效地降低了假阴性率并且在癫痫间的鉴别诊断、分型及癫痫间综合症的诊断方面有重要的临床意义,同时对其他发作性疾病的鉴别提供了可靠的的临床依据。     

Results of prospective 24-hour EEG studies of patients after cranio-cerebral injuries]

In 26 patients 24-hour cassette EEG recording and routine EEG records were taken between 6 and 35 days and again between 6 and 12 months after craniocerebral trauma. Neurological examination and CT of the head demonstrated cerebral concussion in 11 cases and brain contusion in 15 cases. Early after trauma routine EEG was abnormal in 5 cases (19.2%) exclusively in those with brain contusion, and 24-hour EEG recording was abnormal in 16 cases (61.5%), including 7 with cerebral concussion and 9 with brain contusion. In the second half year after trauma 24-hour EEG was normal in 5 cases (19.2%) which had previously abnormal records, and abnormal EEG changes appeared in 6 cases (23.1%) with previously normal findings. Seizure activity was found in the first weeks after trauma in 9 (34.6%) 24-hour recordings. In the second half year after trauma seizure activity was no longer present in 2 cases, but appeared in 6 other cases. Thus 24-hour recording between 6 and 12 months after trauma demonstrated seizure activity in 50% of all patients. In 2 of them epileptic fits developed. The study shows that repeated 24-hour EEG recording after craniocerebral trauma may be important in early detection of patients who are at risk of epilepsy development.     

The relative influence of epileptic EEG discharges, short nonconvulsive seizures, and type of epilepsy on cognitive function

PURPOSE: This study addressed whether cognitive impairment in children with epilepsy is caused by disease-related stable factors, such as the type of epilepsy, or by acute effects of paroxysmal epileptic activity such as epileptic EEG discharges. We studied a nonselected group with short nonconvulsive seizures, as these seizures may elude detection and may therefore persist over a longer period. In this group, the diagnostic issue is to differentiate between the combined effects of several epilepsy-related factors on cognition. METHODS: All children were assessed with 32-channel EEG, synchronized with a computerized cognitive test system and a video-monitoring system. Recording time was 2 h. The primary inclusion criteria were unclear seizures and fluctuations in cognitive performance and/or frequent epileptic EEG discharges in a recent EEG. RESULTS: One hundred fifty-two patients met the inclusion criteria; 31 patients appeared not to have a diagnosis of epilepsy and were used as a nonepilepsy control group. Our results show that type of epilepsy has an impact on stable cognitive functions, such as educational achievement. Paroxysmal epileptic activity (acute effects of seizures and epileptic EEG discharges) affects primarily transient mechanistic cognitive processes (alertness, mental speed). CONCLUSIONS: These results suggest that the effects of paroxysmal epileptic activity on transient cognitive mechanisms may accumulate over time and consequently affect the more stable aspects of cognitive function such as educational achievement. The clinical relevance is that early detection of the cognitive impact of seizure-related activity and subsequent treatment may prevent its detrimental impact on cognitive and educational development.     

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。     

Hemiparetic forms of cerebral palsy in relation to epilepsy and mental retardation

Fifty-one children with hemiparetic cerebral palsy underwent clinical, EEG and CT examinations to assess mental performance, laterality of CP and incidence of epilepsy, 80 per cent of the children had epileptic abnormalities on EEG, but less than half had clinical signs of epilepsy. Clinical paroxysms were more frequent in those with right-sided hemiparesis. Focal or epileptic EEG changes were usual in those with right-hemisphere involvement, but unless clinical paroxysms developed, these had no bearing on mental performance. Lower IQ was found in the patients with clinical epilepsy--in nearly all cases with left-sided hemiparesis and in half of those with right-sided hemiparesis.     

Diminished regional cerebral blood flow during the intercritical period in temporal lobe epilepsy

Hemisphere and regional cerebral blood flow (CBF) were determined during interictal periods by intravenous Xenon 133 in 43 patients considered to have "temporal" epilepsy and presenting complex partial attacks with altered consciousness and lateralized EEG anomalies predominant in the temporal region. Brain scans were normal in all cases. Three subgroups were differentiated according to EEG and polygraphic examinations during sleep; temporal epilepsy with left or right EEG anomalies, with asynchronous bilateral EEG anomalies, with alternating labile unilateral EEG anomalies. Measurements of CBF were compared with those of normal subjects (n = 13) of comparable age and with those of epileptic patients with cerebral lesions on CT scan (n = 4). In epileptics with left EEG anomalies CBF was diminished by about 25 p. 100 in the left temporal region and from 15 to 22 p. 100 in other regions of the ipsi- and contralateral hemisphere. In epileptics with right EEG anomalies CBF was diminished by 20 p. 100 in the right temporal region but not on the left. CBF in the third group was comparable to that of normal subjects. In epileptics with abnormal CT scans the reduction in CBF could be correlated with EEG and CT scan findings. Studies were also conducted to determine variations in reactivity to CO2 in the areas with reduced flow, during ictal and interictal periods. Results emphasize the value of CBF measurements for investigation of epileptic foci. The importance of areas of reduced blood flow as a parameter of severity and course is discussed, as well as their pathophysiological significance.     

Magnetic resonance imaging in relation to EEG epileptic foci in tuberous sclerosis

In 20 patients with tuberous sclerosis (TS), who were sequentially treated for epilepsy at our clinic, the high signal lesions in the cerebral cortex and subcortex detected on T2 weighted magnetic resonance imaging (MRI) were compared with the interictal EEG findings. In four cases who showed a unilateral distribution of the MRI lesions, there was a good correlation between the laterality of the affected lobes and the localization of the EEG epileptic foci. Thirteen cases with more than four affected lobes in both hemispheres also showed bilateral epileptic foci on EEG. The MRI lesions in the occipital lobes showed the best correlation with the EEG epileptic foci, while the worst correlation was seen in the frontal lobes. In addition, the cases with four or more affected lobes without laterality on MRI are more likely to show bilateral synchronization on EEG. The prognosis of epilepsy in these cases was found to be rather poor.     

Late onset epileptic seizures A retrospective study of 250 patients

A retrospective study of 250 patients with late-onset epilepsy was carried out. The ages ranged from 22 to 88. The seizures were partial in 104 patients and generalized in 146. The neurological examination was abnormal in 41 patients and normal in 209. The EEG studies and CT scan revealed abnormalities in 76.5% and 50.8% respectively. The most frequent CT scan findings were diffuse atrophy (19.2%), tumors (16.4%) and cerebral infarct (8.8%). The clinical parameters which best predicted the CT scan abnormalities were an abnormal neurological examination and simple partial seizures. In seven of the 45 patients with space-occupying lesions, the clinical examination and EEG were normal. The etiology of the convulsions was established in 201 patients, the most frequent cause being chronic alcoholism (62 cases), tumors (41 cases), postischemic vascular epilepsy (33 cases) and postraumatic epilepsy (28 cases). We conclude that a CT scan is essential in the assessment of patients with epileptic convulsions of late onset, even when the EEG and clinical examination are normal.     

蝶骨电极在颞叶癫痫中的定侧定位价值

目的 观察蝶骨电极对颞叶癫痫的定侧价值.方法 对无法通过无创手段定侧而高度怀疑为难治性颞叶癫痫的患者,行颅内电极植入术定侧,同步记录双侧蝶骨电极.对最终确诊的颞叶癫痫患者,分析其同步记录脑电图,测量颅内起源到双侧蝶骨电极记录到发作的时间间隔,计数非连续3小时内发作间期双侧蝶骨电极癫痫样放电的数目.结果 癫痫病灶侧蝶骨电极记录到发作(6.1±1.5秒)要早于对侧蝶骨电极(7.2±1.6秒).间期癫痫病灶侧蝶骨电极癫痫样放电数目在大多数情况下(86.37%)要多于对侧蝶骨电极.结论 蝶骨电极在颞叶癫痫的定侧方面可以起到重要的作用.     

热凝毁损杏仁核对痫性放电的抑制作用

目的探讨热凝毁损杏仁核对头皮痫性放电的抑制作用。方法对本院2005年1月~2006年5月收治的58例癫痫患者常规进行24小时视频脑电监测、偶极子分析,对有痫性放电的患者机器人辅助立体定向引导深部电极植入杏仁核,记录其电活动,其后热凝毁损杏仁核,复查深部电极和头皮脑电。结果58例癫痫患者全部记录到头皮棘尖波,56例(96.55%)存在杏仁核痫性放电。热凝毁损杏仁核后,其痫性放电消失42例,明显减少14例,无无效者,复查头皮脑电棘尖波消失20例,明显减少32例,无明显差别者6例。结论热凝毁损杏仁核可明显抑制包括颞叶内侧放电的半球痫性放电。     

Heart rate increase in otherwise subclinical seizures is different in temporal versus extratemporal seizure onset: support for temporal lobe autonomic influence.

Ictal heart rate was investigated in otherwise subclinical epileptic seizures to test the hypothesis as to whether ictal tachycardia is physiological and not a physical or psychological stress response. In addition, we aimed to evaluate the localizing significance of pure ictal tachycardia. We included 21 epilepsy patients, who showed an ictal EEG seizure pattern during 22, otherwise subclinical seizures. All patients underwent ictal video-EEG recordings to evaluate the possibility of resective epilepsy surgery. The changes in heart rate in these patients were investigated in order to determine their relationship to localization and duration of EEG seizure patterns. Ictal tachycardia was observed in 41% of the otherwise subclinical seizures (nine out of 22), and significantly more often in seizures arising from the temporal lobe than from extratemporal regions (62% versus 11%, p < 0.0018). The seizure duration as defined by EEG was significantly positively correlated with an increase of heart rate (p = 0.043). Ictal heart rate can increase as a result of epileptic activation of autonomic cortex, reflecting a temporal lobe autonomic influence. Thus, measurement of heart rate should be included in the evaluation of otherwise subclinical epileptic seizures, because of its localizing value.     

立体定向热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫

目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫癎患者的临床表现、影像学（CT/MRI）脑电图（EEG/VEEG）资料和手术疗效。所有病例术前均行动态脑电图检查明确致癎灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致癎灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12～42个月，13例癫癎未再发作（满意），4例发作次数减少75%以上（明显改善），2例发作次数减少50%（改善）。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫癎，采用立体定向手术行海马杏仁核热凝毁损是控制癫癎发作的一种安全有效方法。     

Magnetic Resonance Imaging and Late-Onset Epilepsy

The value of magnetic resonance imaging (MRI) in investigation of patients with late-onset epilepsy has not been studied systematically. We evaluated prospectively the usefulness of MRI in 50 patients with late-onset epilepsy in whom a computed tomography (CT) scan was normal (32), did not allow a definitive diagnosis to be made (12), or showed irrelevant lesions (6). Patients were assessed clinically and had an EEG, and CT and MRI scans were reported by one neuroradiologist blinded to clinical and laboratory data. Of the 32 patients with a normal CT scan, MRI was normal in 20, showed irrelevant ischemic lesions in 8, and showed the cause of seizures in 4 patients. Of the 12 patients with nondiagnostic CT, MRI clarified the diagnosis in 5 and was normal in 2 patients. In 6 patients, both scans showed irrelevant ischemic lesions, and in 1 patient MRI showed a relevant additional lesion. The incidence of MRI-detected white matter ischemic lesions was no greater than in an age- and sex-matched group of subjects without seizures. MRI was diagnostic in 32% of the patients with partial seizures and/or focal EEG findings, as compared with 0% of patients without focal features (p less than 0.01). We conclude that MRI is useful in investigation of patients with late-onset epilepsy with focal features.     

National General Practice Study of Epilepsy (NGPSE): partial seizure patterns in a general population.

The National General Practice Study of Epilepsy (NGPSE) is a prospective community-based study of newly diagnosed epileptic seizures. Of 594 patients with definite epileptic seizures, 160 (26.9%) had seizures with a clinically localizable onset: 36 (22.5%) frontal, 52 (32.5%) central sensorimotor, 43 (27%) temporal, nine (5.6%) frontotemporal, and 10 each (6.3%) parietal and other posterior cortex. There was no difference among these groups in seizure frequency or remission rate; 46.5% were seizure free and 6.9% had severe epilepsy. Etiology was identifiable in 41% and focal CT and EEG abnormalities in 33% and 19%, with results discordant with the clinical seizure localization in 21% and 20%. Temporal lobe epilepsy may be underreported, as it may be more difficult to localize clinically. Extratemporal seizures are extremely common in the general population, especially frontal and central sensorimotor, in relation to cerebrovascular disease. Prognoses are similar for partial epilepsies with different clinical patterns and regions of onset and are much better than suggested in hospital-based studies. The clinical, EEG, and CT localizations may frequently be discordant in this nonrefractory group.