临床下脑电图痫样放电对认知功能的损害

无明显癫痫发作症状的临床下脑电图痫样放电患者,50％以上出现短暂性认知受损表现,影响其心理社会功能和学习训练能力,甚至日常生活技能;以抗癫痫药抑制这种放电可明显改善这一状况,显示临床下痫样放电是认知功能受损的重要原因之一。     

临床下脑电图痫样放电的研究(综述)

临床下痫样放电现象在临床上较为常见，通过脑电图和神经心理尤其认知功能的测试。正确识别临床下痫样放电及其导致的短暂性认知损害。有助于临床诊断和干预。     

癫痫患者痫样放电时间分布与临床

我院从１９９６年１０月至１９９８年３月采用北京明思公司研制激光动态脑电图系统，对临床诊断为癫痫的患者进行２４ｈ监测，共检出典型痫样放电（尖、棘、尖慢、棘慢综合波）患者２４８例，对痫样放电时间进行了统计学分析并应用于临床，现报告如下：资料与方法我们从１...     

广泛性临床下痫样放电的精神发育迟缓患儿抗癫痫治疗效果研究

目的探讨广泛性临床下痫样放电的精神发育迟缓患儿抗癫痫治疗的效果。方法自2005年1月1日至2006年6月30日在我科确诊为广泛性临床下痫样放电的精神发育迟缓患儿50例，随机分成试验组和对照组，全部患儿接受脑营养药物、康复训练治疗．试验组添加丙戊酸钠，分别评估患儿在实验开始时和6个月后的认知发育水平，并检查自然睡眠脑电图。结果47例完成了本研究，于6个月时试验组脑电图改善显著较对照组满意（P〈0．001），认知指数显著高于对照组（P〈0．05）。结论对于广泛性临床下痫样放电的精神发育迟缓患儿，在康复训练的同时经积极抗癫痫治疗后，脑电图中癫痫样放电得到抑制，认知功能发育显著加快。     

癫痫患者痫样放电的压缩谱阵研究

目的：评价ＣＳＡ对癫痫的检测价值，探讨痫样放电在ＣＳＡ上的特点，方法：用脑电监护仪连续记录清醒与睡眠期脑电后，以２ｓ为单元作离线ＣＳＡ分析，结果ＣＳＡ可清晰地显示出清醒期与浅睡期的散频发中高幅放电与１ｓ认上的阵发放电，而不能显著出散在性少量放电与低幅放电；不同的放电类型在ＣＳＡ上具有不同的特征，结论对于癫痫ＣＳＡ能在效且应主要应用于放电频繁的癫痫或癫痫状态的监护，并对发作类型的判断有一定参考价值。     

伴中央-颞区棘波的儿童良性癫痫患儿临床下痫样放电对认知功能的影响

目的　探讨BECCT患儿临床下放电对认知功能的影响。方法　在录像脑电图监测下,对20例BECCT患儿静脉注射氯硝西泮(0.03~ 0.05 mg/kg)抑制临床下放电后,进行 ERP测定及神经心理学测验,并与用药前所测各项认知功能指标进行比较。结果　BECCT患儿临床下放电被抑制后,FSIQ升高(P <0.05),短时视觉记忆增强(P <0.01),而PIQ、VIQ及P3潜伏期用药前后均无显著性差异。结论　临床下放电可能是引起 BECCT患儿认知功能损害的重要原因之一,有效抑制临床下放电,可能会改善患者认知功能。     

年龄相关性癫痫样放电与认知功能的相关性

癫痫样放电对于认知功能的作用非常复杂,它不同于癫痫发作之影响,在临床上没有得到足够的重视。本文就其机制、特点、相关性和治疗进行综述。     

癫痫患者脑电图痫样放电相关因素及临床意义

目的 分析癫痫患者脑电图痫样放电的相关因素及临床意义。方法 对用２４ｈ便携式磁带记录脑电图（ＩＥＥＧ）检出痫样放电的１６２例癫痫患者进行相关因素分析。结果 在临床表现为全面性发作患者，ＡＥＥＧ可检出有明确定位价值的颅内局灶性异常。睡眠时期痫样放电检出率为８０％，痫样放电主要出现于ＮＲＥＭⅠ－Ⅱ期（７９％），清醒期及睡眠期均出现痫样放电的７４例患者中其局灶性异常（６７％）均出现于睡眠期，痫样放电仅出     

Risk for developing epilepsy and epileptiform discharges on EEG in patients with febrile seizures

Purpose: The aim of the present study was to investigate the correlation between epileptiform discharges on EEGs after febrile seizures and the prognosis of patients in terms of the development of epilepsy and recurrence of febrile seizures. This study also evaluated the characteristics of epileptiform discharges and EEG changes on follow-up examination. Methods: This study consisted of 36 children who presented to our hospital with febrile seizures and whose electroencephalograms (EEG) showed epileptiform discharges. The development of epilepsy and the recurrence of febrile seizures were compared between the study group (n = 36) and the control group (n = 87), which included children with febrile seizure but with normal EEG findings. Results: No significant correlation was detected between the recurrence rate of febrile seizures in patients with normal EEG (23 out of 87, 26.4%) findings and that of patients whose EEGs showed epileptiform discharges (12 out of 36, 33.3%) [adjusted OR 0.67 (0.26–1.68)]. However, 9 (25.0%) out of 36 patients with epileptiform discharges on EEG had epilepsy compared to 2 patients (2.3%) in the control group. The correlation was statistically significant [crude OR 10.88 (2.47–47.88) and adjusted OR 8.75 (1.49–51.6)]. Conclusion: Epileptiform discharges on the EEGs of patients with febrile seizures are important predictive risk factors of the development of epilepsy.     

左乙拉西坦治疗癫（癎）伴认知功能障碍患儿疗效观察

目的 分析左乙拉西坦治疗癫（癎）伴认知功能障碍患儿的临床疗效.方法 选择在本院接受治疗的癫（癎）伴认知功能障碍患儿作为研究对象,分别给予常规治疗及左乙拉西坦治疗,比较2组患儿的认知功能、脑电活动情况及生活质量评分等差异.结果 观察组总有效率（66.67%）、MMES评分（25.47±4.83）、无认知功能障碍（83.33%）、躯体功能（76.87±7.16）、心理功能（59.32±5.34）、社会功能（58.76±2.16）、总体生活质量（82.34±8.21）评分均明显高于对照组（P〈0.05）;癫（癎）样放电（15%）、α波（18.21±3.36）、β波（10.32±2.25）、δ（12.36±2.25）、θ波（20.32±3.24）数目均明显少于对照组（P＜0.05）.结论 左乙拉西坦可有效改善癫（癎）伴认知功能障碍患儿的认知功能,减少异常脑电活动,提高生活质量.     

EEG autoregressive modeling analysis: A diagnostic tool for patients with epilepsy without epileptiform discharges

ObjectiveNumerous types of nonepileptic paroxysmal events, such as syncopes and psychogenic nonepileptic seizures, may imitate epileptic seizures and lead to diagnostic difficulty. Such misdiagnoses may lead to inappropriate treatment in patients that can considerably affect their lives. Electroencephalogram (EEG) is a commonly used tool in assisting diagnosis of epilepsy. Although the appearance of epileptiform discharges (EDs) in EEG recordings is specific for epilepsy diagnosis, only 25%–56% of patients with epilepsy show EDs in their first EEG examination.MethodsIn this study, we developed an autoregressive (AR) model prediction error–based EEG classification method to distinguish EEG signals between controls and patients with epilepsy without EDs. Twenty-three patients with generalized epilepsy without EDs in their EEG recordings and 23 age-matched controls were enrolled. Their EEG recordings were classified using AR model prediction error–based EEG features.ResultsAmong different classification methods, XGBoost achieved the highest performance in terms of accuracy and true positive rate. The results showed that the accuracy, area under the curve, true positive rate, and true negative rate were 85.17%, 87.54%, 89.98%, and 81.81%, respectively.ConclusionsOur proposed method can help neurologists in the early diagnosis of epilepsy in patients without EDs and might help in differentiating between nonepileptic paroxysmal events and epilepsy.SignificanceEEG AR model prediction errors could be used as an alternative diagnostic marker of epilepsy.     

Global cognitive function in children with epilepsy: a community-based study

PURPOSE: To determine the frequency and determinants of subnormal global cognitive function in a representative, community-based sample of children prospectively identified at the time of initial diagnosis of epilepsy. METHODS: In children enrolled with newly diagnosed epilepsy and followed a median of 10.5 years, level of cognitive function (within normal, borderline, mild, moderate to severe mental retardation (MR), neurologically devastated, and impaired but not further classified (NFC)) was determined based upon neurologists' and school records, repeated parental interviews, and, in over half the participants, standardized neuropsychological testing. For multivariable analyses, subnormal cognitive function was designated as consistent with a full scale IQ < 80. RESULTS: Global cognitive function was considered within normal, N = 451 (73.6%), borderline, N = 31 (5.1%), mild MR, N = 21 (3.4%), more severe MR, N = 45 (7.3%), devastated, N = 29 (4.7%), and impaired-NFC, N = 36 (5.9%). Age at onset <5 years, symptomatic etiology, epileptic encephalopathy, remission status and current AED treatment were each strongly associated with level of cognitive function (all p-values <0.0001). In a multivariable logistic regression model, all variables except remission status independently contributed to subnormal global cognitive function. DISCUSSION: Evidence of subnormal global cognitive function is apparent in approximately one of four children with epilepsy. Young age at onset, symptomatic cause, epileptic encephalopathy, and continued treatment, despite their strong intercorrelations, are independently associated with this outcome.     

Lateralized effects of subclinical epileptiform EEG discharges on scholastic performance in children

The interaction between lateralization of subclinical epileptiform discharges and cognitive tasks was investigated in 21 children (12 girls and 9 boys, mean age 10.6 years). Seventeen had a diagnosis of epilepsy (partial or secondarily generalized). Testing was by reading, arithmetic, and intelligence subtests during continuous telemetric EEG and video monitoring. Children with left-sided discharges had significantly lower reading performance than children with right-sided discharges. During reading, epileptiform discharges occurred relatively less frequently and with a shorter total duration over the left hemisphere than the right. This supports the view that cognitive tasks suppress epileptiform discharges when they activate a region of the brain within the epileptogenic zone. Discharges from other epileptogenic zones not directly activated by the tasks are increased, however.     

Frequency of bitemporal independent interictal epileptiform discharges in temporal lobe epilepsy

PURPOSE: Bitemporal interictal epileptiform discharges (IEDs) occur in < or =42% of scalp EEGs in patients with temporal lobe epilepsy (TLE) studied with routine EEGs or partial analysis of long-term recordings. METHODS: Twenty-eight patients with TLE demonstrating exclusively unilateral temporal IEDs on routine EEGs underwent 24-h continuous recording. The entire record was visually inspected for epileptiform discharges. We used continuous EEG to assess the significance of long-term recording in detecting bilateral IEDs. RESULTS: Twenty-two patients had left temporal IEDs; 21 had right temporal IEDs. Seventeen (61%) patients had IEDs originating from both the right and left temporal lobes. The probability of detecting bilateral independent IEDs was correlated with the duration of continuous EEG recording. There was no correlation between the number of IEDs originating from one side and the probability of detecting independent IEDs on the other side. The frequencies of IEDs were not correlated with the length of time since onset of epilepsy. CONCLUSIONS: The findings suggest that when long-term recordings are performed, the incidence of bilateral discharges in TLE is higher than previously reported in the literature and supports the view that TLE is commonly a bilateral disease.     

Effect of epilepsy, seizures and epileptiform EEG discharges on cognitive function

Patients with an established diagnosis of epilepsy were included in three groups on the basis of the absence (Group 2) or presence (Group 3) of epileptiform EEG discharges or subtle seizures (Group 4) during the cognitive assessment procedure. A separate age-matched non-epileptic control group (Group 1) was formed. Twenty-five patients were included in each of the four groups. Thus, a total of 100 patients were investigated. The patients were assessed with continuous 21-channel EEG and video-monitoring, combined with cognitive testing. The results show consistently lower performance on cognitive tests for Group 4, the group with subtle seizures. The difference with the control group was significant for the intelligence subtests and for the complex information processing test (p<0.05). No transient cognitive impairment was found. The results are discussed in the light of possible factors that may be responsible for the lower test-scores in the patients of Group 4: both the ictal effects of the seizures themselves, postictal effects and the effects of the epileptiform EEG discharges may have had an impact on cognitive performance. Finally the absence of evidence for transient cognitive impairment in a group with frequent epileptiform EEG discharges is discussed in detail.     

The cognitive effects of interictal epileptiform EEG discharges and short nonconvulsive epileptic seizures

Purpose: Educational difficulties or even severe cognitive deterioration is seen in many childhood epilepsy syndromes. Many of those cognitive deficits are related directly to the brain disorder underlying the epilepsy syndrome. However, in other types of epilepsy, the epileptic seizures and/or epileptiform activity can be the dominant factor. This is especially unknown for the more “subtle” short nonconvulsive seizure types. For this reason, we analyzed a new cohort of children. Methods: A cross‐sectional study of 188 children with epilepsy. Electroencephalography (EEG)–video recordings and cognitive testing were performed simultaneously. The results of children with short nonconvulsive seizures during a 2‐h testing session were compared with all children with epilepsy without seizures during the 2‐h cognitive testing session and with controls without epilepsy. In a second analysis the cognitive effects of frequency of epileptiform EEG discharges were analyzed. Key Findings: The cognitive effects of short nonconvulsive seizures were large, ranging from 0.5 to 1 standard deviation and concerned global cognitive function, speed of central information processing, and memory function. In children without seizures during cognitive testing, the occurrence of frequent epileptiform discharges showed more subtle effects. These effects were independent from the occurrence of short nonconvulsive seizures. Significance: We concluded that although the effect is less pronounced in number of areas involved and magnitude, the type of association between frequent epileptiform activity (>1% of the time) and cognitive function in children with epilepsy is comparable to the association between short nonconvulsive seizures and cognitive function.