颅脑CT阴性的癫痫患者的脑电研究

本文报告11例头颅扫描阴性的癫痫患者的脑电研究,11例均经EEG、BEAM等检查发现颞(或额)叶原发棘(尖)波等痫性放电灶。术中在ECOG定位指导下切除痫性病灶,经病理检查发现8例神经细胞胶质增生及神经细胞肿胀变性;3例为脑隐匿性微血管畸形。EEG棘(尖)波等痫灶和局灶性慢波有一定的病理基础,EEG波形改变的类型和预后有相互关系。     

小儿抽动症66例的临床与脑电图分析

目的分析脑电图(EEG)检查对小儿抽动症的临床诊断及价值。方法选取我院收诊的小儿抽动症患儿66例,对其EEG检查结果进行回顾性分析,观察EEG检查对于患儿的临床诊断的价值。结果本组66例患儿,EEG检查结果,在正常范围的患儿48例,异常18例;EEG的异常表现:背景活动轻度非特异性异常患儿14例,其中包括α波指数有减少,基本节律比同龄儿童较慢;阵发性异常患儿5例,其中包括棘慢波、尖波、中央区、额区、颞区少量散发棘波;描记时实时的记录抽动发动32例,且同期AEEG、EEG未发现同步发作性异常波,在抽动前后,发现脑波无明显的改变。其中48例患者进行头颅MRI或CT检查,未发现异常。结论 EEG检查可用于小儿抽动症的诊断以及鉴别诊断中,为临床诊断该病提供重要依据,是一种可靠的辅助检测手段。     

44例阿尔茨海默病患者认知功能与脑电图特点分析

目的对44例阿尔茨海默病(AD)患者的认知功能及其脑电图(EEG)改变进行回顾性分析,并探讨两者之间的关系。方法自2013年10月²014年10月间,就诊于吉林大学第一医院认知障碍门诊的44例诊断为阿尔茨海默病的患者,对其临床资料、临床痴呆评定量表(CDR)、简易精神状态量表(MMSE)、蒙特利尔认知评价量表(Mo CA)、日常生活活动能力量表(ADL)及4 h录像脑电图监测结果进行回顾性分析研究。结果 EEG异常率84.1%,表现为背景节律减慢,单侧或双侧颞区出现不同程度尖波、尖慢波、棘波和棘慢波发放,以右侧颞区为主。AD患者EEG异常程度与病程及认知功能减退程度相平行。结论 EEG可作为反映AD患者认知功能较为可靠的客观指标,对掌握病情进展和判断预后有着重要作用。     

儿童睡眠中癫痫性电持续状态相关性癫痫综合征的脑电图特征及与临床预后的关系

目的 分析儿童睡眠中癫痫性电持续状态(ESES)相关性癫痫综合征的脑电图(EEG)特征及与临床预后的关系。方法 分析92例ESES相关性癫痫综合征患儿的临床资料及EEG资料,统计临床预后并分析其与发作间期癫痫样放电指数(IEA)的关系。结果 92例患儿的EEG表现中,单侧放电占63.04%,棘慢波频率>2.0Hz占51.09%,放电部位多见于额区(29.35%)、颞区(23.91%)和中央区(15.22%)。治疗后3、6个月,患儿的IEA值明显减低,FIQ值明显升高(P<0.05),IEA值指数与总智商(FIQ)值呈显著负相关性(r=-0.532,P<0.01)。治疗6个月后,有效率92.39%,且随着预后变差,IEA明显增高而FIQ明显降低(P<0.05)。结论 ESES相关性癫痫综合征患儿具有复杂的EEG特征,且与智力状态及临床预后密切相关。     

伴有中央颞区棘波的儿童良性癫痫同步脑电图-功能磁共振研究

目的 研究伴有中央颞区棘波的儿童良性癫痫(BCECTS)患者发作间期棘波相关的血氧依赖水平(BOLD)变化情况. 方法 选择海南医学院附属医院神经内科自2010年1月至2011年12月收治的频繁出现发作间期放电的BCECTS患者进行同步脑电图(EEG)联合功能磁共振(EEG-fMRI)扫描,将离线EEG滤波后确定棘波的时间点,采用统计参数图软件(SPM)提供的经典血氧动力学函数(HRF)模型计算棘波相关的BOLD变化. 结果 共纳入6例BCECTS患者,常规EEG显示频繁出现发作间期中央区和中颞区棘波.EEG-fRI扫描时1例未见放电,获得5例患者5个序列的fMRI数据,5个序列均出现BOLD激活信号,两侧中央颞区同时出现激活信号2例,单侧中央颞区出现激活信号3例,4例最大激活区位于中央-中颞区,1例位于枕叶.5例在中央颞区外的其他脑区具有激活信号. 结论 中央颢区可能是BCECTS的致痫灶,致痫灶与其他部位共同构成的神经网络可能与BCECTS的发生相关.     

小儿手足口病并发脑炎的EEG诊断及对预后分析

目的探讨脑电图(electroencephalogram,EEG)对于小儿手足口病并发脑炎的应用及意义。方法回顾性分析103例临床确诊为小儿手足口病并发脑炎的患儿EEG的改变。结果本组EEG正常2.9%,异常率97.1%,主要表现为弥漫性慢波,部分出现阵发性尖(棘)波或尖(棘)-慢波。结论 EEG可作为小儿手足口病并发脑炎的诊断标准之一及判断小儿手足口病并发脑炎严重程度的价值指标;EEG的动态监测可作为小儿手足口病并发脑炎临床判断病情转归的一项指标。     

自闭症儿童脑电图特点及β频带功率分析

目的:分析自闭症儿童的脑电图特点及β频带功率.方法:选择2008～2012年在我院脑电图室检查的自闭症患儿并设对照组,分析其脑电图特点及β频带功率.结果:38例2岁零3个月至8岁的患儿中,脑电图正常范围15例,非药物性β活动增多11例,背景活动慢化及节律失调5例;伴尖波、棘波7例,其中6例为局灶性放电,主要在中央、中后颞区,1例为少量阵发广泛性棘慢波.睡眠期额区尖形θ波2例;枕区α节律较同龄儿快1例.自闭症组额区β功率为(5.22±2.35)μV2,中央区为(4.63±2.82)μV2,对照组额区β功率为(4.49±2.07)μV2,中央区为(3.29±2.07)μV2,P＞0.05,差异无统计学意义.结论:自闭症患儿的脑电图常伴有不同类型的非特异性异常,明显高于正常儿童,主要表现为非药物性快波增多、局灶性(痫)样放电、背景节律慢化和节律失调等.自闭症患儿额、中央区β频带功率与对照组相比差异无统计学意义.     

额叶癫痫的临床特点及脑电图分析

目的探讨额叶癫痫的临床特点及脑电图改变。方法抽取2011-06—2013-06在我院就诊的60例额叶癫痫患者为研究对象,分析患者的临床特点及脑电图改变情况。结果临床发作次数共148次,每例患者平均发作2.5次,其中100次为睡眠期间发作,48次为清醒期间发作;发作主要表现为全身强直阵挛、发声发作及偏转性强直等。额叶癫痫脑电图主要特点为放电部位以额区为主49例(81.67%),主要发作频率为偶发/阵法54例(90.00%),常见的节律为阵发性棘(尖)波或棘(尖)慢波38例(63.33%)。结论对于额叶癫痫,主要的临床特点为全身强直阵挛、发声发作及偏转性强直,且在夜间发作较为常见,脑电图的主要形式为额区偶发/阵发性棘(尖)波或棘(尖)慢波。     

玩麻将诱发癫癎发作13例患者脑电图分析与临床提示

目的 分析玩麻将诱发癫癎患者发作间期脑电图(EEG)变化的特点及临床意义.方法 回顾性分析2006年7月～2011年3月在本院癫痫 间中心行长程(8～24h)视频EEG监测的13例因玩麻将诱发癫癎患者发作间期的EEG改变.结果 本组中有2例表现为全身强直-阵挛发作的患者发作间期EEG可见双侧大脑半球或双侧中央、额区多量单、连发棘波、尖、棘慢复合波、多棘波慢波发放,给予抗癫痫 间药物治疗,并嘱避免打麻将,未再发作.9例全身强直-阵挛发作和2例部分性发作继发全身性发作的患者发作间期EEG背景活动均出现不同程度的一种或多种异常改变,表现为α节律慢化、反应性及调节性消失、慢波性异常、快波性异常增多、清醒及浅睡眠中6或14Hz阳性棘波、中线θ节律.11例均未给予抗癫痫 间药物治疗,只嘱戒掉麻将并远离麻将环境.其中有1例发作间期EEG呈广泛间断性中-高幅5-7Hzθ节律,1例呈双侧额、中央、颞区阵发性高波幅3～5Hz慢波节律的患者在看家人打麻将、或通宵玩麻将中再次发作.结论 玩麻将诱发的癫癎属于反射性癫癎,虽然戒掉麻将是避免发作的最佳方法,但对于EEG检查有明显癫痫 间样放电,或遵医行为不良,不能彻底摆脱打麻将或麻将环境的患者,则应按癫癎发作类型正规服用抗癫癎药物.同时由于玩麻将诱发癫痫 间发作的刺激因素非常复杂,声光等视觉刺激、思考、躯体感觉、本体感觉、焦虑、惊吓、激动、劳累等刺激因素影响常使大脑处于过度兴奋、乏氧状态,导致EEG背景活动不同程度的改变,在患者情况允许的前提下应定时行长程EEG监测.     

癫癎临床发作时脑电图误诊27例分析

目的 提高对癫(癎)发作时非棘、尖波样波群以外的有别于背景波的NFDCC性波的演变过程. 方法 对治疗后EEG复查的癫(癎)患者,有临床发作事件而未能发现(癎)性波,与回顾性回放有不同结果的27例视频EEG进行分析.结果 正常2例,发作间歇期有(癎)样波或发作与EEG异常不同步者3例.发作性θ波6例,δ波5例,快波4例,低电压2例,多棘-慢波5例. 结论 熟练掌握非棘、尖波样波群以外的有别于背景波的(癎)性波的演变过程及规律.减慢回放实时速度可大大减少漏诊率.     

剥夺睡眠脑电图在癫诊断中的应用

目的 分析睡眠脑电图(EEG)在癫诊断中的价值及适应证.方法 对200例癫病人的睡眠及清醒脑电图进行研究.结果 脑电图有异常爆发活动(PA)者80例,PA只在睡眠中出现者30例,样放电检出率由清醒的25%提高到睡眠的40%.结论 睡眠脑电图对提高样放电的检出率和进一步明确癫发作类型有重要意义.     

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。     

癫痫的多导睡眠研究

目的:了解癫痫放电在自然睡眠各期及觉醒状态下分布情况,为癫痫的诊断与优化治疗提供客观参考依据。方法:筛选40例全身性强直—阵挛发作尚未用AEDs治疗的癫痫患者,用英国OXFORD Medilog 9200型动态脑电监测仪同时进行多导睡眠记录和动态脑电图记录。结果:40例中有33人记录到典型癫痫波(82.5%),30人记录到慢波阵发(75%),11人记录到α高尖阵发(27.5%)。结论:本研究提示典型癫痫放电和慢波发放主要在W和S_(1,2)较多,其次是在REM,在S_(3,4)相对较少,α高尖阵发主要是在W和S_(1,2),这说明痫样放电在觉醒和睡眠时均有相当的放电时间和次数。本研究还提示通过动态脑电图检测或结合多导睡眠图可详细准确了解痫样放电的24小时分布状况,对指导调整AEDs的用量和服用时间,实现癫痫优化治疗有重要意义。     

Prevalence of epileptiform activity in healthy children during sleep

BACKGROUND: The term epileptiform discharge typically refers to interictal paroxysmal activity that occurs more commonly during sleep. This type of paroxysmal activity does not include the electroencephalographic (EEG) activity observed during a seizure. The prevalence of epileptiform activity in the general pediatric population is unknown. METHODS: Polysomnographic (PSG) studies were conducted in otherwise healthy children recruited from the general population and with no previous history of seizures or any other medical conditions. All sleep studies included an eight-lead EEG montage. Spike and sharp waves, either alone or accompanied by slow waves, occurring singly or in bursts lasting <5s were considered as representing epileptiform activity. RESULTS: Nine hundred seventy children underwent overnight PSG. In 14 children, evidence of epileptiform activity, in the absence of any additional abnormality in the PSG, occurred. Thus, the prevalence of epileptiform activity was 1.45%. Epileptiform patterns found were either spike or spike and wave and were more prominent during non-rapid eye movement (NREM) sleep, with 11 patients presenting spike and spike and wave patterns in the centro-temporal regions. Four of the six children who underwent neurocognitive tests exhibited abnormal findings in areas of behavior, attention, hyperactivity, and learning. CONCLUSION: Epileptiform activity in otherwise healthy children from the community is relatively frequent and, if confirmed by prospective studies, could be associated with suboptimal cognitive and behavioral functions. Increased awareness by sleep professionals and use of PSG montage that includes temporal leads and >2 standard EEG leads should facilitate the detection of epileptiform activity in children.     

Ripple classification helps to localize the seizure‐onset zone in neocortical epilepsy

Purpose: Fast ripples are reported to be highly localizing to the epileptogenic or seizure‐onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic, since the IED is not a normal physiologic event. Methods: We studied 35 patients with epilepsy with neocortical epilepsy who underwent invasive electroencephalography (EEG) evaluation by stereotactic EEG (SEEG) or subdural grid electrodes. Interictal fast ripples and ripples were visually marked during slow‐wave sleep lasting 10–30 min. Neocortical ripples were classified as type I when superimposed on epileptiform discharges such as paroxysmal fast, spike, or sharp wave, and as type II when independent of epileptiform discharges. Key Findings: In 21 patients with a defined SOZ, neocortical fast ripples were detected in the SOZ of only four patients. Type I ripples were detected in 14 cases almost exclusively in the SOZ or primary propagation area (PP) and marked the SOZ with higher specificity than interictal spikes. In contrast, type II ripples were not correlated with the SOZ. In 14 patients with two or more presumed SOZs or nonlocalizable onset pattern, type I but not type II ripples also occurred in the SOZs. We found the areas with only type II ripples outside of the SOZ (type II‐O ripples) in SEEG that localized to the primary motor cortex and primary visual cortex. Significance: Neocortical fast ripples and type I ripples are specific markers of the SOZ, whereas type II ripples are not. Type I ripples are found more readily than fast ripples in human neocortical epilepsy. Type II‐O ripples may represent spontaneous physiologic ripples in the human neocortex.     

电视录像脑电图在癫痫及其他发作性疾病中的诊断价值探讨

目的：评价电视脑电图（Video-EEG)监测在癫痫及其他发作性疾病临床诊断中的应用价值。方法：对216例具有各种发作性症状的患者进行连续24h的包括清醒、睡眠及诱发试验的Video-EEG监测。结果：216例患者中130例（60．2％）监测到临床发作，其中53例伴有发作期痫样放电，证实为癫痫性发作；73例发作期及发作间期均无痫样放电，为非癫痫性发作。216例患者中共80例监测到了痫样放电，其中64例通过发作期的脑电－临床表现和（或）发作间期的EEG特征，结合有关病史资料确定了癫痫的发作类型，27例监测后发作分类得到了修正。结论：Video-EEG可提高痫样放电的检出率，有助于癫痫发作与非癫痫发作的鉴别及癫痫的分型。     

EEG features in transient global amnesia

Forty-seven patients with one or more episodes of transient global amnesia (TGA) were studied by means of standard and 24-hour ambulatory cassette recording electroencephalography (EEG). Only one individual, with a left frontal hemorrhage, had intracranial lesions. TGA was multiple in 16 of the patients (34%), the attacks recurring with an average time span of one every 3 years. No patient required anticonvulsant therapy and all episodes of TGA were self-limited and rather benign. Only 13 patients were known to be hypertensive and 2 had a history of classic migraine. The average time span of EEG recordings after TGA was 2.7 days. Three individuals had recordings during the actual clinical attack, 2 of whom had paroxysmal abnormalities (one with periodic lateralized epileptiform discharges and the other with left temporal sharp wave and central spike and wave discharges). The remaining patient had no change in the EEG. The percentage of EEG abnormalities encountered was 36% (17 patients) but only 10.6% (5 patients) disclosed specific paroxysmal activity. Activation procedures, sleep and 24-hour ambulatory studies were overall of no additional value to the standard recordings. TGA seemingly represents a benign circulatory disturbance affecting the memory zones of the brain, rather than a primary epileptic disorder.     

Electroencephalographic studies in children with autism spectrum disorders

An important factor in the diagnosis and treatment of Autism spectrum disorder (ASD) is prescribed Electroencephalography (EEG). EEG changes may show the following: slowing, asymmetry, sharp waves or spikes, sharp and slow waves, generalized sharp and slow waves, or generalized polyspikes in a distributed or general area, multifocal or focal, unilateral or bilateral, and they may be located in many different areas of the brain. There is a need to look for a EEG phenotype typical of patients with ASD. The importance of gamma waves, rhythm mu, mirror neurons, and their role in patients with ASD was discussed. Epilepsy is reported to occur in one third of ASD patients. In ASD, seizures and EEG paroxysmal abnormalities could represent an epiphenomenon of a cerebral dysfunction independent of apparent lesions. This article reviews ASD and EEG abnormalities and discusses the interaction between epileptiform abnormalities and cognitive dysfunction.     

心、脑电Holter同步监测原因不明的阵发性室上性心动过速

目的 了解中青年不明原因的阵发性室上性心动过融洽审否与脑部的痫性放电有关。方法 利用心，脑电Holter同步监测，观察出现心动过速是否同时有脑部的痫样放电，对有痫性放电的病人按癫痫用卡马西治疗。4个月后评价药物疗效。结果 60例病人中有34例中在监测过程中记录到心动过速，其中13例同步记录的脑电图上有痫性放电。加用卡马西平治疗后10例发作停止，2例无效，1例失访。结论 中青年原因不明的阵发性室上性心动过速可能部分与癫痫发作有关，心，脑电Holter的同步监测是明确诊断最有用的工具。     

EEG characteristics predict subsequent epilepsy in children with febrile seizure

The role of electroencephalography (EEG) in the work-up of febrile seizure (FS) remains controversial. We investigated the importance of EEG characteristics, especially the localizations of paroxysmal discharges, as predictors for subsequent epilepsy. Patients were referred from the outpatient department for EEG within 7-20 days after the seizure. EEGs were classified as paroxysmally abnormal based on the presence of spikes, sharp waves, or spike-wave complexes, whether focal or generalized, that were considered abnormal for age and state. Of 119 patients with FS, 26 (21.8%) revealed paroxysmal abnormality on EEG and 9 (7.6%) developed epilepsy. Of nine patients with later epilepsy, 6 (66.7%) revealed paroxysmal EEG abnormality. Of 26 patients with paroxysmal abnormality, 6 (23.1%) developed epilepsy. Of 10 patients with generalized paroxysmal spike and wave activity, one (10%) developed epilepsy. Of seven patients with rolandic discharge (RD), two (28.5%) developed epilepsy. Of four patients with paroxysms in the frontal region, three (75%) developed epilepsy. Of five patients with paroxysms in the occipital region, none developed epilepsy. Compared with generalized EEG foci, the relative risk (RR) for patients with frontal EEG foci was 27.0. Patients with frontal EEG paroxysms had a significantly higher risk of developing epilepsy than those with paroxysms in other regions of EEG foci (p=0.035). These findings suggest that patients with FS presenting with frontal paroxysmal EEG abnormalities may be at risk for epilepsy. In patients with frontal paroxysmal EEG abnormalities, serial EEG should be performed, even though it does not contribute to treatment.