视频脑电图诊断非癫癎性发作的价值

为了解视频脑电图对非癫Jian性发作的诊断价值，对252例拟诊或排除癫Jian的患儿进行视频脑电图检查。结果：共监测到发作52例，非癫Jian性发作35例，其中睡眠期肌阵挛10例，睡眠障碍6例，习惯性抽动5例，歇斯底里2例，非癫Jian性发作性强直4例，行为异常4例，头痛、腹痛发作2例，百日咳发作、婴儿拥抱反射各1例；癫Jian性发作17例，其中强直和阵挛性发作4例，强直性发作4例，阵挛性发作3例，局限运动性发作2例，复杂部分性发作、肌阵挛性发作、婴儿痉挛、大田原综合征各1例。结果表明，视频脑电图是鉴别发作性质及类型的最有效的检查方法，也是鉴别癫Jian与非癫Jian性发作的有效方法。     

脑电图在儿科临床应用中的几个问题

座谈内容　 1　脑电图的特征及临床应用进展　 2　儿童脑电图判断中常见的误区　 3　脑电图对癫疒间 发作类型和癫疒间 综合征的诊断价值　 4　脑电图在小儿热性惊厥和脑炎诊断中的价值　 5　脑电图在特殊脑炎和脑病诊断中的应用　 6　视频及动态脑电图对癫疒间 诊断与鉴别诊断的意义　 7　临床没有癫疒间 发作的脑电图疒间 样放电是否可诊断为癫疒间 ,是否需要治疗　 8　癫疒间 发作已控制而脑电图长期不正常是否可以停药　 9　脑电图是否可以预测中、短期的癫疒间 发作　 10　什么是“癫疒间 样放电” ,其对癫疒间 诊断的特异性和敏感性如…     

儿童假性癫(疒间)发作临床特征与视频脑电图的诊断价值

目的　探讨儿童假性癫疒间发作的临床特征及视频脑电图对其的诊断价值。方法　分析 2 5例假性癫疒间 患儿的临床特征及视频脑电监护结果 ,并与 2 5例癫疒间比较。结果　假性癫疒间 组发病前均有诱发因素 ,临床表现多种多样 ,发作时意识清楚 ,并可记忆发作时的情况 ,视频脑电监护无疒间样放电。结论　视频脑电监护可同步观察患儿发作时的表现和脑电活动情况 ,对鉴别诊断假性癫疒间 有重要临床价值。     

视频脑电监测在睡眠相关事件鉴别诊断中的应用价值

目的 评价视频脑电监测在诊断小儿睡眠相关事件中的实用价值.方法 对临床有睡眠相关事件发作的276例患儿进行夜间 8～12 h的视频脑电图动态监测,监测中对各种状态及事件进行标记,结束后将记录的EEG与临床录像资料同步回放分析.结果 276例患儿中,58例未监测到临床发作,218例监测到临床发作.监测到发作的218例患儿中伴脑电图异常放电诊断为癫痢者75例,占34.4%,不伴脑电图异常放电者143例,占65.6%.结论 视频脑电监测足明确小儿睡眠相关事件发作的种类、鉴别非癫(疒间)性与癫(疒间)发作的可靠检查方法.     

视频脑电图诊断儿童非癫疒间发作的临床意义

目的探讨视频脑电图(video-EEG)诊断儿童非癫疒间发作(NES)的意义和影响其诊断的因素.方法对57例经video-EEG监测后诊断为NES患儿的临床资料作回顾性分析.结果 57例NES中生理性发作36例(63.2%),其中头痛病例15例(41.7% 15/36);心因性发作21例(36.8%,21/57).其中NES合并癫疒间者7例,单纯NES癫疒间样波检出2例;9例中脑部有器质性病变者5例,包括NES合并癫疒间2例、单纯NES 3例.结论 video-EEG对鉴别NES与癫疒间发作具有重要价值.NES合并癫疒间、单纯NES合并亚临床发作、脑部器质性病变是影响NES诊断的因素.     

儿童额叶癫疒间临床与视频脑电图特征分析

目的探讨额叶癫疒间临床发作表现及视频脑电图特征。方法对2005年6月-2007年6月长程脑电监测者中符合额叶癫疒间的20例患儿临床发作及视频脑电图特征进行回顾性分析。结果20例患儿共监测到临床发作50次。临床发作形式主要表现为:偏转发作、姿势性强直、过度运动,部分患儿发作合并有发声或自动症。白天夜间均有发作,夜间发作较多。半数以上发作间期脑电图无癫疒间波。临床发作期脑电图大多数有异常,但不典型,可表现为额极及额区的尖波节律、慢节律、快节律、棘节律或尖-慢波、棘-慢波,或以上混合,有时可波及到颞区、中央区甚至泛化全导。发作频繁者背景活动有慢化。卡马西平、奥卡西平可以减少发作甚至控制发作。结论额叶癫疒间临床发作以偏转发作、姿势性强直、过度运动为主,以夜间为主,持续时间短。剥夺睡眠长程脑电监测可提高额叶癫疒间诊断率,特别是发作期脑电图,有利于额叶癫疒间的诊断与鉴别诊断。卡马西平、奥卡西平治疗有效。     

轻度胃肠炎伴婴幼儿良性惊厥248例临床及预后分析

目的：探讨轻度胃肠炎伴婴幼儿良性惊厥的临床特点及预后。方法对248例符合轻度胃肠炎伴婴幼儿良性惊厥诊断的患儿进行临床分析,并随访12个月以上。结果发病年龄3月龄~3岁;1次病程中惊厥发作2次以上者124例,惊厥发作5 min以上者64例;头颅CT/MRI检查、脑电图检查,均未见异常;血糖、血电解质均正常,脑脊液常规、生物化学检查正常,脑脊液细菌涂片和培养均为阴性;随访中有14例(5．6%)出现复发,12例(4．8%)出现热性惊厥,8例(3．2%)转化为癫疒间。结论轻度胃肠炎伴婴幼儿良性惊厥多数病例预后良好,少数病例有向热性惊厥及癫疒间转化的可能,在轻度胃肠炎伴婴幼儿良性惊厥后出现热性惊厥的患儿转化为癫疒间的可能性较大,且轻度胃肠炎伴婴幼儿良性惊厥在惊厥频繁发作时对中枢神经元会造成损伤,若再次有惊厥发作应及时就诊,以免延误诊治。     

小儿神经系统疾病诊断治疗进展

20 0 2年国内有关小儿神经疾病诊治工作的研究进展可概括为以下 3个方面 ,现简述如下。1　癫疒间 与惊厥性脑损伤①通过对 2 0 0 1年国际抗癫疒间 联盟关于癫疒间 发作和对癫疒间 诊断新建议的讨论 ,国内对正确进行癫疒间 发作和癫疒间综合征分类的重要性有了更新和更深入的认识。如该新建议提出不需将“热性惊厥”诊断为癫疒间 ,但确认“全面性癫疒间伴热性惊厥附加症 (GEFS+ )”这一新的癫疒间 综合征 ;②视频脑电图 (video EEG)和动态脑电图日益在更多医院应用。这不仅对癫疒间 性发作类型的诊断与鉴别 ,而且对区分非癫疒间 及其发作…     

婴儿良性部分性癫

婴儿部分性癫疒间 在历史上曾经一度被认为是预后不良的癫疒间 类型之一 ,甚至被称为难治性癫疒间 。然而 ,在近大约15年的研究中 ,人们似乎逐渐认识到了某些婴儿部分性癫疒间的良性过程 ,在癫疒间 病学领域引入了婴儿良性部分性癫疒间的概念 ,为癫疒间 的分类学提出了新的挑战。Watanabe是此项研究的先驱 ,他在 1987年对 9例复杂部分性发作的日本婴儿进行了临床、脑电图及随访研究后 ,最早提出了婴儿良性复杂部分性癫疒间 的概念。Yamamoto等[1] 对 7例 2岁以内的复杂部分性发作的患儿进行了研究 ,指出这些孩子均智力发育良好且无神经系统…     

小儿癫疒间部分性发作发作姿势与脑疒间样放电部位关系探讨

目的　探讨小儿癫疒间部分性发作时口角歪斜、头眼转向及肢体的肌张力不全性姿势对脑疒间 样放电部位的定位意义。方法　通过家长问卷调查和录像脑电图监测观察。结果　通过问卷调查和视频监测获得的发作时临床表现对疒间样放电部位均具有良好的相关性。在本组患儿中 ,发作时口角歪斜及眼转向的发生率分别为45 83 %和 5 4 17% ,发作时转向放电的对侧的相关系数分别为 - 0 6 38和 - 0 6 77。头颈转向的定位意义不肯定。一侧肢体肌张力不全性姿势发生在对侧 ,其相关系数为 - 0 90 83。结论　口角歪斜、眼球向一侧凝视及肌张力不全性姿势在小儿癫疒间 的部分性发作中对脑疒间 样放电的部位有明显的定位意义     

��Ƶ�Ե�ͼ��Ӥ�׶�����ڼ��Է�������ϼ�ֵ

?? Diagnostic value of video??EEG in infants with non??epileptic seizures. Shen Nanping,Hua Ying.Wuxi Children??s Hospital,Wuxi 214002,China AbstractObjectiveTo evaluate the diagnostic value of video??EEG in infants with non??epileptic seizure. MethodsFrom Jan.2004 to Jan.2005,152 infants suspected to have or need to weep out the possibility of epilepsy were examined with video??EEG in our clinics. ResultsNon??epileptic seizures 51:including non??epileptic tonic seizures 10 ??benign nocturnal myoclonus 8?? breath??holding spell 7??mashturbstion??like episodes 6??cerebral palsy 5??benign myoclonus of early infancy 5??benign infantile convulsions associated with mild gastroenteritis 4??other nonepileptic episodes 6. ConclusionThe results indicate that the video??EEG is not only the most sensitive way to differentiate the seizure characteristics and patterns,but also the most effective way in differenting epileptic seizures from the non??epileptic seizures.     

视频脑电图在睡眠相关发作性疾病中的诊断价值

目的探讨视频脑电图在睡眠相关发作性疾病的诊断与鉴别诊断中的应用价值。方法收集2005年1月～2006年6月在我院儿科病房和门诊就诊的具有与睡眠相关发作性症状患儿65例。其中拟诊癫痫35例,非性发作性疾病30例。全部行常规脑电图（EEG）和视频脑电图（VEEG）检查。结果拟诊癫痫35例,性波阳性率VEEG为62.86%（22/35）,EEG为17.14%（6/35）,有显著性差异（χ^2=15.23P〈0.01）;经EEG监测,结合其临床表现,确诊癫痫27例中,额叶癫痫2例,颞叶癫痫1例,儿童良性癫痫伴中央中颞区棘波7例;VEEG检查其中样放电22例（81.48%）,睡眠期18例（81.82%）,清醒期11例（50%）,睡眠相关性癫痫睡眠期异常放电率高于清醒期（χ^2=4.96P〈0.05）;共监测到发作22例,其中非癫痫性发作15例（睡眠肌阵挛10例、睡眠障碍3例、阵发性肌张力不全,生长痛各1例）。结论VEEG是鉴别发作性质及类型的最有效检查方法,也是鉴别癫痫与非癫痫性发作的有效方法。     

伴有非癫癎发作的322例脑性瘫痪临床分析

目的：了解伴有非癫癎发作的脑性瘫痪（脑瘫）的临床特点,以提高与癫癎发作的鉴别能力。方法：1 198例9个月至6岁的脑瘫患儿纳入研究,对伴随发作性症状的患儿进行24 h视频脑电图监测,明确伴随的发作是否为癫癎发作,并观察伴随非癫癎发作患儿的发作症状、年龄、脑瘫型别及脑电图特征。结果：共578例（48.24%）患儿伴随发作性症状,其中伴随癫癎发作者231例（19.28%）,非癫癎发作322例（26.88%）。322例伴随非癫癎发作的脑瘫患儿中,发作性症状包括非癫癎性强直发作、发作性摇头、耸肩或头后仰、发作性哭闹、惊恐发作、睡眠肌阵挛、刻板性运动等;158例（49.1%）显示脑电图有非特异性异常;111例（34.5%）在基层医院误诊为癫癎;1岁以内患儿非癫癎发作频率高于1岁~和3~6岁组患儿;痉挛型脑瘫患儿非癫癎发作频率最高（168例,52.2%）,其次为不随意运动型（69例,21.4%）和混合型(65例,20.2%)。结论：脑瘫患儿伴随的发作性症状部分为非癫癎发作,注意与癫癎发作相鉴别。非癫癎发作发生频率与患儿年龄及脑瘫型别有一定关系。［中国当代儿科杂志,2010,12(12)：933-935］     

婴儿癫发作特征的录像脑电图分析

目的　分析婴儿癫发作的录像脑电图 (Video EEG)特征。方法　根据癫发作分类法对 45例婴儿 10 6次癫发作的Video EEG资料进行分析。结果　 (1)全身性发作包括 :①全身性粗大肌阵挛 8例 32次发作 ,发作期EEG为阵发性全导棘慢波、多棘慢波或弥漫性低电压 ,肌阵挛与EEG相关性良好 ;②散发游走性肌阵挛 3例 ,面部及肢体远端频发间断肌阵挛 ,EEG为广泛持续慢波及多灶性棘波、尖波 ,肌阵挛与EEG无相关性 ;③婴儿痉挛 10例 17次发作 ,背景EEG为高峰节律紊乱 ,发作期为高波幅爆发和 (或 )低波幅抑制。全身性发作中缺乏完整的全身强直 阵挛性发作及失神发作。(2 )部分性发作 16例 42次发作 ,突出表现为无动性凝视 ,其次为简单自动症、植物神经症状及轻微的惊厥性症状。多数意识状态难以准确判断。EEG提示发作起源于额区、中央区、颞区或枕区。部分性继发全身性发作 5例 7次发作 ,EEG提示阵发性放电分别起源于颞区 2例 ,枕区 2例及多灶性 1例。(3)不能分类的发作 3例 5次发作 ,Video EEG主要表现为在 1次发作中出现多种发作类型。结论婴儿期癫发作在识别和分类上都比较困难。Video EEG监测同步分析有助于对婴儿癫发作的准确观察与分类。     

视频脑电图监测对儿童癫癎分类诊断的价值

目的探讨发作期视频脑电图监测(VEEG)对癫分类诊断的价值。方法对诊断或临床拟诊癫的73例患儿采用VEEG监测。VEEG监测前由神经专科医师根据患儿的年龄、发作频率、临床表现等资料确定发作类型;VEEG监测后,对同步的视频和脑电信号根据需要随意转换为多种导联方式回放分析,由神经与脑电图专业医师根据患儿的年龄、发作的频率、描记到的发作表现、同步的脑电及间歇期的脑电图表现等资料共同确定发作类型,并将监测前后的分类结果进行对比。结果监测前根据临床表现,确定全面性发作80.8%(59/73),局限性发作19.2%(14/73)。监测后根据描记到的发作表现、同步的脑电及间歇期的脑电,确定全面性发作57.5%(42/73),局限性发作42.5%(31/73)。监测前后类型一致39例,不一致34例。结论发作期的临床表现及VEEG为癫分类诊断提供重要的依据。     

应用多项神经电生理技术对婴儿痉挛临床发作特征的综合研究

目的应用多项电生理技术观测婴儿痉挛（IS）的临床发作特征,探索痉挛、肌阵挛和强直性发作的临床．电生理鉴别要点。方法应用视频脑电一肌电多导记录及抽搐逆向锁定的脑电平均技术（ierk-locked back averaging,JLA）,对8例1岁以下IS婴儿的681次临床明显发作（包括经测试最后被摒除的20次非皮层性肌阵挛）,进行临床和多项电生理的实时联合记录分析。同时以其中1例Aicardi综合征Is临床发作前2个月的58次肌阵挛发作为对照。结果8例IS共记录到3种发作形式,包括痉挛、肌阵挛和强直性发作,分别占94．4％（624／661次）、4．5％（30／661次）和1．1％（7／661次）。痉挛发作多为轴性肌群收缩,具有丛集性及“渐强-渐弱”特征,85．7％（535／624次）的痉挛发作时间在0．4—3.0s间,14．3％（89／624次）持续3—7S。此外,还根据发作期EEG认定273次微小痉挛发作。发作期脑电图多为全脑性高幅慢波或低-中幅快波活动（89．1％）,经JLA叠加后发作期脑电与肌电间未见明确锁时关系。肌阵挛为闪电样的肌肉收缩,发作时间〈400ms,发作期脑电图或为痫性放电,或无明显改变。经JLA叠加后证实痈性肌阵挛有皮层放电波,且与肌电之间有恒定锁时关系。强直性发作持续3s以上,脑电图为低幅快波及中幅θ活动。此外,根据强直痉挛的强直达峰时间〈2s、发作期EEG及轴性发作与IS一致等特点,可与强直性发作区别。结论IS临床以痉挛发作为主,借助多导电生理记录及JLA等电生理技术,能满意地对痉挛、强直性痉挛、肌阵挛和强直性发作等婴幼儿期常见癫痫发作进行鉴别,从而有助对婴儿期癫痫的正确诊断、分类与治疗。     

Benign convulsions in newborns and infants: Occurrence, clinical course and prognosis

Background

During early development severe epilepsies may appear, some with well established occurrence. Benign non-epileptic and epileptic paroxysmal syndromes with excellent prognosis occur in the same period. There are no exact data on their occurrence.

Aim

We have reviewed medical histories of children with benign non-epileptic or benign epileptic events: benign myoclonus of early infancy, benign neonatal sleep myoclonus, benign sleep myoclonus in infancy, benign partial epilepsy in infancy (BPEI) and benign infantile familial convulsions (BIFC) were established. The occurrence, clinical characteristics and prognosis of these syndromes were evaluated.

Methods

Inclusion criteria were met in 31 children. Research included retrospective analysis of clinical characteristics, laboratory values, neuroimaging and neurophysiological assessments, followed by evaluation of psychosocial development with the use of the Strengths and Difficulties Questionnaire (SDQ), fulfilled by parents.

Results

In our group the incidence of benign non-epileptic convulsions was 6.69 per 10 000 live births and the incidence of benign epileptic convulsions was 1.35 per 10 000. Male/female ratio in the group of children with non-epileptic events was 2.1:1. Among non-epileptic group 5 out of 23 children and among epileptic group 3 out of 8 children had minimal, mild or moderate abnormalities at neurological assessment at the time of the first clinical examination. Nonspecific changes in laboratory values were seen in 6 out of 23 in the non-epileptic and in 1 out of 8 children in the epileptic group. Neurophysiological assessments showed subtle changes in 4/23 in the non-epileptic and 6/8 in the epileptic group. Neuroimaging was not optimal in 5/23 with non-epileptic and 3/8 with epileptic events. Analysis of SDQ did not show significant deviations in psyhosocial development. Statistically significant deviation was observed only in relations with peers (p = 0.009).

Conclusions

Benign neonatal and infantile convulsions are more frequent than severe epilepsies of the same age period. Results show higher proportion of males with benign non-epileptic conditions. No deviations in further development was found. Laboratory values, neuroimaging and neurophysiological assessments were normal or nonspecifically changed.     

Cerebral blood flow velocity during neonatal seizures.

AIM: To determine if cerebral blood flow velocity increases during all types of neonatal seizure, and whether the effect is due solely to an increase in blood pressure, transmitted to the cerebral circulation when autoregulation is impaired. METHODS: Seizures were diagnosed in 11 high risk neonates using cotside 16 channel video-EEG polygraphy. EEG, cerebral blood flow velocity (CBFV) using transcranial Doppler ultrasound, and arterial blood pressure (ABP) measurements were made. At least two 5-10 minute epochs of simultaneous measurements were performed on each infant. These epochs were then reviewed to eliminate artefacts, and one minute data periods containing a clear seizure onset were created. Each period contained 20 seconds before the seizure. Data periods without seizures from the same infants were also analysed and compared with seizure periods. RESULTS: Four infants had purely electrographic seizures-without clinical manifestations. Six infants had electroclinical seizures. One infant displayed both seizure types. A random effects linear regression analysis was used to determine the effect of seizures on CBFV and ABP. A significant increase was found in mean CBFV in those periods containing seizures. The mean percentage change in velocity for all infants was 15.6%. Three infants showed a significant increase in mean ABP after seizures but the overall increase in ABP for all infants was not significant. CONCLUSION: Electroclinical and electrographic neonatal seizures produce an increase in CBFV. In some infants the increase is not associated with an increase in blood pressure. These preliminary results suggest that electrographic seizures are associated with disturbed cerebral metabolism. Treatment of neonatal seizures until electrographic seizure activity is abolished may improve outcome for these infants.     

Differential diagnosis of cerebral seizures]

Several non-epileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy and they must be considered in the differential diagnosis. Some of these disorders are discussed in the present review: vasovagal, vasomotor and cardiac syncopes, breath holding spells. Among the sleep disorders, parasomnias, nightmares and the benign neonatal sleep myoclonus are mentioned. Migraine with aura, alternating hemiplegia and benign vertigo of childhood are probably related disorders. Benign myoclonus of early infancy, paroxysmal choreoathetoses and pseudoepileptic or hysterical seizures are further non-epileptic attack disorders to be considered in the differential diagnosis.     

Paroxysmal non-epileptic events resembling seizures in children with otitis media

Children may frequently present with recurrent spells, which are often thought to be seizures. However, there are several benign non-epileptic conditions that mimic seizures. A group of 8 children is described who were diagnosed with otitis media and presented with recurrent, stereotypic spells suggestive of seizures. A paroxysmal phenomenon, in association with otitis media, resembling seizures, has not been previously described. These paroxysmal phenomena resembling seizures may be related to acute otitis media and should be included in the differential diagnosis of paroxysmal non-epileptic events in infants and young children.