脑电图诊断颞叶癫痫的价值探讨

目的探讨脑电图检查在颞叶癫痫诊断中的价值。方法选取许昌市中心医院2015-02—2016-02收治的78例颞叶癫痫患者,均经临床检查确诊为颞叶癫痫。所有患者实施常规脑电图、长程脑电图、动态脑电图及蝶骨电极不同时长脑电图检查,分析检查结果。结果长程脑电图、动态脑电图癫痫波检出率分别为54.2%(13/24)、66.7%(16/24),差异无统计学意义(P0.05);清醒期、睡眠期癫痫波检出率分别为31.3%(15/48)、54.2%(26/48),差异有统计学意义(P0.05);常规蝶骨电极、长程蝶骨电极癫痫波检出率分别为25.0%(4/16)、71.4%(10/14),差异有统计学意义(P0.05)。结论在颞叶癫痫患者的临床诊断过程中,实施脑电图检查的效果显著,且蝶骨电极、睡眠诱发试验能促使颞叶癫痫诊断准确性得到提升。     

额叶癫癎发作的癫癎灶定位

目的 通过分析40例额叶癫痫发作患者术前定位的临床资料，探讨额叶癫痫发作的癫痫灶综合定位方法。方法 应用临床发作症状评估、MRI／CT扫描、单光子发射计算机体层摄影术(SPECT)检查、长程视频脑电图监测以及颅内电极记录等方法综合定位额叶癫痫患者的癫痫灶。结果 应用非侵袭性检查可以为45．0％的患者进行额叶癫痫灶定位；结合颅内脑电图长程记录，癫痫灶定位率可达90．0％；当影像学检查阴性时，78．9％的患者可以定位癫痫灶。结论 应用临床发作症状学评估、影像学检查、长程视频脑电图监测以及颅内脑电图长程记录相结合的综合定位方法，可以显著提高额叶癫痫发作的癫痫灶定位效果。     

128导长程视频脑电图系统在癫痫灶定位中的应用

目的 报告顽固性癫痫病人进行多导长程视频脑电图监测，了解癫痫灶定位的方法与价值。方法 回顾性分析105例顽固性癫痫病人的发病、检查及癫痫灶的定位分析结果与过程，分析了其检查的准确性及影响因素。结果 对视频脑电图的直接人工分析定位率为81％，结合临床症状、偶极子定位分析准确率可以达到91．4％，且均可以达到与术中皮层脑电图检查定位一致或基本一致。结论 128导长程视频脑电图是一种无创、准确的癫痫灶定位手段。     

老年癫痫患者常见病因与临床特征分析

目的分析老年癫痫患者常见的病因与临床特点、脑电图特点及预后。方法 156例患者根据年龄分为对照组(72例)和老年组(84例),2组患者均行脑部CT、MRI和脑电图检查,比较病因、癫痫发作特点、脑电图检查结果及预后。结果对照组病因以脑动静脉畸形、外伤和遗传因素为主;老年组病因以脑血管疾病为主。对照组61例患者脑电图检查结果异常,老年组73例患者脑电图检查结果异常,差异无统计学意义(P>0.05)。老年组以部分发作为主,患者的伴随症状发生率低于对照组,差异具有统计学意义(P<0.05)。对照组患者预后优于老年组,差异具有统计学意义(P<0.05)。结论老年癫痫患者以部分性发作的脑血管疾病为主。     

8例自身免疫性脑炎的病例分析并文献复习

目的探讨自身免疫性脑炎的临床表现、磁共振(MRI)图像、脑脊液特点及治疗转归。方法回顾性分析我院8例(自2012年1月-2016年1月)自身免疫性脑炎患者的临床资料。结果 8例患者平均发病年龄为44岁,其中有4例抗NMDA受体脑炎,3例LGI1蛋白抗体阳性边缘系统脑炎,1例抗GABABR脑炎,所有患者(100%)均有认知功能损害和精神症状;5例(62%)出现癫痫发作;3例(37%)出现不自主运动和自主神经功能障碍。4例(50%)患者脑电图存在异常;4例(50%)患者有磁共振检查异常信号;1例发现肺癌。结论以认知功能损害、精神行为异常、癫痫发作为主要表现的患者,要警惕自身免疫性脑炎的可能,以免误漏诊。     

颞叶海绵状血管瘤继发癫痫的外科治疗

目的探讨颞叶海绵状血管瘤继发癫痫的临床特点及手术疗效。方法收集自2010年1月—2019年1月于武汉脑科医院神经外科以癫痫起病的颞叶海绵状血管瘤行手术治疗的患者38例,其中男17例,女21例,年龄8～57岁,平均(40.05±14.64)岁;病程1～10年,平均(1.25±2.19)年。临床表现为复杂部分性发作7例,部分性发作继发全身性发作8例,全身强直-阵挛性发作23例。所有患者术前均行头部断层扫描(CT)和核磁共振(MRI)检查,同时行长程视频脑电图(VEEG)监测。结合临床特点、影像学及VEEG监测结果,在皮层脑电图(ECoG)监测下行海绵状血管瘤显微手术切除,必要时加行前颞叶切除或皮层热灼术,术后随访通过Engel分级以评估手术的疗效。结果所有患者术后病理检查均证实海绵状血管瘤的诊断,术后随访1～9年发现,36例患者疗效满意,癫痫无发作,效果较差2例,手术有效率为94.74%(36/38)。结论对于颞叶海绵状血管瘤继发癫痫的患者,在手术切除海绵状血管瘤的同时,应一并切除胶质瘢痕和含铁血黄素沉积带,必要时可加行前颞叶切除术或皮层热灼术。若术中探查困难,可借助神经导航和术中B超对病灶进行定位,且术后癫痫控制一般均较好。     

偶极子定位在癫痫术前定位诊断中的应用

目的 联合应用常规长程视频脑电图(video electroencephalography)、偶极子定位(dipole localization method)、颅内皮层电极和深部电极脑电图(electrocorticography and depth electrodes,EEG)对致痫灶进行定位,比较VEEG、DLM与ECoG and DEEG的符合情况,探讨偶极子定位技术在癫痫患者术前定位诊断中的价值.方法 收集30例已经确诊为癫痫的患者,分别进行常规长程视频脑电图、偶极子定位、颅内皮层电极和深部电极脑电图检查,比较常规EEG、偶极子定位技术与颅内EEG定位的一致性.结果 偶极子定位技术的符合率明显高于常规EEG,二者相比有显著性差异(P＜0.05);额叶癫痫、颞叶癫痫在各项术前定位检查中符合情况的比较均无显著性差异(P＞0.05).结论 偶极子定位技术是一种无创性定位方法,对局灶性癫痫有明确的定位意义,对于常规长程视频脑电图检测为单一病灶者,可替代侵入性颅内电极检查.     

难治性颞叶癫痫的手术治疗方式及其疗效研究

目的 探讨难治性颞叶癫痫的临床特点、术前评估方法、手术治疗方式及其疗效。方法 105例难治性颞叶癫痫患者术前行头部CT及MRI检查,同时加行双侧海马磁共振波谱分析(MRS);并均行长程视频脑电图检查。根据患者的术前临床发作特点、影像学和长程视频脑电图检查结果,在术中皮层脑电图监测下行手术治疗。术后随访患者1年以上,观察手术的疗效。结果 本组患者中,48例海马硬化患者行前颞叶切除术(包括大部分海马及杏仁核);另外57例有其他病灶的患者先行病灶切除术,复查皮层脑电图其中23例患者仍有异常放电,对这23例患者加行前颞叶切除术(包括大部分海马及杏仁核),前颞叶切除后有5例患者仍有异常放电,予以皮层热灼术。手术疗效:术后80例患者的癫痫发作完全消失,13例患者较术前明显缓解,12例患者无明显变化;总有效率为88. 6%,优良率为76. 2%。结论 颞叶癫痫的发作形式有一定的临床定位价值,如果患者的神经影像学和视频脑电图检查结果一致,则强烈建议手术治疗。手术一定要在皮层脑电图监测下进行;同时术中在切除颞叶病变后,应根据皮层脑电图监测结果加行前颞叶切除术,必要时再加行皮层热灼术,以解决双重病理现象。     

长程脑电图监测对癫痫无发作患者停药后复发风险的预估

目的对癫痫无发作患者停用抗癫痫药物之前脑电图异常放电的独立风险因素进行分析,探讨通过长程脑电图监测预估癫痫无发作患者停药后复发风险的临床价值。方法对2009-01—2011-12在盐城市第四人民医院神经内科门诊经过抗癫痫药物治疗,癫痫无发作3a以上的62例原发性癫痫患者,减药、停药前行长程脑电图监测,停药后进行2~3a的随访。结果停药前有癫痫样放电患者21例,无癫痫样放电41例;有癫痫样放电患者减、停药1a内复发6例,复发率28.6%,停药后2~3a复发3例,复发率14.3%,总体复发率42.9%;无癫痫样放电患者停药后1a内复发4例,复发率9.7%,停药后2~3a复发2例,复发率4.9%,总体复发率14.6%。两者复发率差异有统计学意义(P0.05)。结论抗癫痫药物治疗后3a以上癫痫无发作的患者不论减、停药前长程脑电图监测有无异常都有一定的癫痫复发率,而脑电图有异常放电的患者减、停药后复发率高,停药后复发风险大,长程脑电图监测对癫痫无发作患者停药后复发风险的预估有重要的临床价值。     

胼胝体切开术治疗难治性癫痫30例疗效及脑电图分析

目的探讨胼胝体前部切开术对难治性癫痫的疗效及与脑电图变化的相关性。方法对我院神经外科2013-01-01-2014-06-30入院被确诊为难治性癫痫,并行胼胝体前部切开术的30例患者,手术前后均行长程视频脑电图监测,临床资料完整,术后随访3~24个月。结果 (1)术后患者均继续口服常规量控制癫痫药物,术后3个月内未发作12例,余在随访期内,很少发作2例,发作较前减少75%以上6例,无发作较前减少50%~75%5例,无明显改善4例,症状加重1例。(2)未发现癫痫术后患者临床症状改善与脑电图改变具有明显相关性。(3)手术并发症均较轻,多呈一过性表现,无死亡病例。结论 (1)当前胼胝体切开术对于顽固性癫痫仍是一种重要的辅助治疗措施。(2)患者手术前后长程脑电图监测捕捉癫痫灶对于定位致痫灶,区分手术适应证及手术后效果的预判等均具有重要参考价值。(3)胼胝体切开术治疗癫痫尚存在许多未达成共识的地方,需临床继续深入探讨总结。     

Long-term EEG monitoring in epilepsy diagnosis

EEG long-term monitorings were carried out in 149 patients using a portable 4-channel miniature recorder system. In most cases EEG was recorded for 48 hours. In addition to preceding routine EEG controls, long-term EEG monitoring disclosed epileptic phenomena in 32.7% of patients suspected for epileptic seizures from their history. This gain of information was based mainly on the detection of abnormal potentials or epileptic seizures appearing during sleep. Using EEG long-term recording numerous EEG routine controls could be replaced which otherwise are often necessary for ensuring the diagnosis of epilepsy. If the patient's history, however, gives only poor reason to believe epileptic seizures, positive findings in EEG long-term monitorings are unlikely. Consequently, careful evaluation of the patient's history is crucial for the indication of this laborious examination. As the limited number of recorder channels may cause false negative results, normal findings should be utilized with caution. Only the sum of all clinical and neurophysiological data should be used for exclusion of suspected epilepsy. The second, even more important application of EEG long-term recordings is the special examination of patients with known epilepsy, such as studies of the circadian profiles of epileptic excitability, documentation of seizure frequency, and electrographic analysis of the course of seizure. Therapy control of epileptic patients can be improved by such informations. In view of the large amount of data which results from long-term recordings, computer assisted methods supporting the visual analysis are necessary. In this regard the continuous spectral analysis of the EEG long-term recordings proved to be highly useful.     

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.     

The Absence of Interictal Spikes with Documented Seizures Suggests Extratemporal Epilepsy

PURPOSE: To determine the demographic and clinical characteristics of patients who have documented epileptic seizures on long-term video-EEG monitoring who do not have interictal spikes. METHODS: The records of 1,223 monitoring studies from 919 patients who underwent noninvasive long-term video-EEG monitoring were reviewed. In 28 patients (3.0% of monitored patients, 4.4% of patients with electrographic evidence of epilepsy), no interictal spikes were found despite the occurrence of at least one recorded electrographic seizure. The demographic, medical, neuropsychological, and EEG data of these patients were compared with those of 28 matched control patients with documented interictal spikes. RESULTS: Extratemporal seizures were significantly more frequent in the patients with at least one recorded epileptic seizure but without interictal spikes compared with patients with epileptic seizures and interictal spikes (p = 0.031). The only other significant difference between the groups (p = 0.016) was a later age at seizure onset (18.3 vs. 10.7 years) for the patients without interictal spikes. Age at evaluation, gender, handedness, clinical seizure type, family history of epilepsy, history of febrile seizures, neuropsychological testing, and neurologic and psychiatric history did not differ between the two groups. CONCLUSIONS: In patients with documented epilepsy without interictal spikes on EEG monitoring, the possibility of an extratemporal focus should be considered.     

Clinical and EEG evaluation of mid-line spikes in childhood

We studied the clinical and electroencephalographic (EEG) characteristics of 45 patients with mid-line spikes. The incidence of mid-line spikes was 3.0% in total EEG population in childhood. Sex incidence was equal. First appearance age of mid-line spikes ranged from one month to 12 years, with a mean of 5.0 years old. Fz focus was in 3 patients, Cz in 31 and Pz in 11. Thirty two of the 45 patients (71%) had a history of clinical seizures; 16 with febrile convulsions and 16 with epileptic seizures. Of the remaining 13 patients without a history of seizures, the EEG was obtained because of post-meningitis in 4, developmental delayed in 4, migraine in 1 and miscellaneous in 4. Mid-line spikes might not have so strong correlations with clinical seizures. Ten patients had a family history of epilepsy and/or febrile convulsion. In the patients with seizures, generalized tonic-clonic seizures were the most frequent type (18; primary GTC and 10; secondary GTC with partial onset). Elementary symptoms of partial seizures were very variable (focal motor in 5, Jacksonian march in 1, aversive in 1, autonomic in 2 and automatism in 5), and which might be related to the other lesions such as temporal and/or frontal lobes. Seizure control was almost good except for two patients with organic brain damage. And other neurological symptoms were not also progressive. On EEG findings, twenty-two patients had midline spikes as their only epileptiform abnormality. The remaining twenty-three had an additional epileptiform feature, either a focal spikes or a generalized spike-wave.(ABSTRACT TRUNCATED AT 250 WORDS)     

Occipital encephalocele and epilepsy]

We report the incidence of epilepsy in 7 patients with occipital encephalocele (meningocele: 6 cases, meningoencephalocystocele: 1 case). Two cases had epilepsy and a case without the history of epileptic seizure had an epileptic pattern on the EEG. All these 3 cases had cortical dysplasia(CD) such as schizencephaly and subcortical gray matter, and two of them were associated with mental retardation. The location of the prominent CD was correlated with the EEG abnormalities and clinical epileptic pattern in each case. Associated hydrocephalus and placement of VP shunt had no significant influence on the occurrence of the epilepsy. Thus, complicated CD is thought to be epileptogenic in patients with occipital encephalocele.     

伴有睡眠中电持续状态癫痫患儿的临床表现及脑电图特点

目的探讨伴有睡眠中癫痫性电持续状态(ESES)的不同癫痫综合征患儿的临床表现及脑电图特点。方法通过长程脑电图监测,对9例合并ESES的癫痫患儿进行神经心理测试、临床资料及脑电图资料的回顾性分析。结果 9例合并ESES的癫痫患儿中,伴中央颞区棘波的儿童良性癫痫5例,韦氏儿童智力量表测定示,无言语及精神发育倒退,药物治疗效果较好;不典型儿童良性部分性癫痫2例,韦氏量表示,认知功能轻中度受损,药物治疗效果欠佳;Lennox-Gastaut综合征2例,均有多种形式的癫痫发作,精神运动发育落后,未能配合韦氏测定,多种抗癫痫药物联合应用无效。结论 ESES不是一个独立的癫痫综合征,而是包括了一系列不同病因、不同临床表现及不同预后的多种癫痫综合征。ESES,是引起神经心理损伤的主要原因,早期识别这种特殊的脑电图现象,早期干预,是改善神经心理损伤的关键。     

Nonconvulsive Status Epilepticus in Adults: Thirty-Two Consecutive Patients from a General Hospital Population

We studied all adult patients who between 1984 and 1989 were initially diagnosed at our hospital as having nonconvulsive status epilepticus. Thirty-two patients fulfilled the criteria, which included ictal EEG recordings. The annual incidence was 1.5 in 100,000 inhabitants. The median age at onset of status was 51 years. Ten patients had status as their first epileptic manifestation, but most patients had a previous history of epilepsy. Median duration of epilepsy at onset of status was 4 years. Fourteen patients had focal ictal seizure activity on EEG and thus met the criteria for complex partial status. Eighteen patients had generalized seizure activity on EEG, but only 6 of these had a history of absence epilepsy or juvenile myoclonic epilepsy. None had Lennox-Gastaut syndrome. The clinical features of status in the remaining 12 patients were in some respects similar to those of the patients with complex partial status. We hypothesize that the EEG seizure activity in these patients may have been generalized from an initial focus.     

Ictal epileptic headache in adult life: Electroclinical patterns and spectrum of related syndromes

ObjectivesBoth headache and epilepsy are frequent paroxysmal disorders that often co-occur or are related in numerous ways. Although ictal epileptic headache has become the focus of several studies, this remains a very rare and not well-known phenomenon. Electroclinical features, pathophysiology, and syndromic context are heterogeneous. We investigated the electroclinical and neuroimaging findings in a population of adult patients with ictal epileptic headache.MethodsWe retrospectively examined 8800 EEG recordings of almost 4800 patients admitted to our video-EEG laboratory from 2010 to 2013 with a history of well-documented epilepsy. We selected patients who reported headache closely related to a seizure documented by video-EEG or 24-hour ambulatory EEG. We analyzed ictal electroclinical features of headache, and we defined the related epileptic syndromes.ResultsWe identified five patients with ictal epileptic headache. Two patients described tension headache during an epileptic seizure. In three patients, the headache was accompanied by other “minor” neurological symptoms mimicking a migrainous aura. In all cases, the headache stopped with the end of the epileptic activity. Three patients had a history of partial symptomatic epilepsy with cerebral lesions (low grade glioma, astrocytoma, porencephalic cyst) in the left posterior regions, whereas two patients were affected by idiopathic generalized epilepsy.ConclusionThis study confirms the rarity of ictal epileptic headache. To date, well-documented video-EEG cases remain as exceptional reports, especially in cases of idiopathic generalized epilepsies. Moreover, we confirm the main involvement of posterior regions in patients with ictal epileptic headache affected by partial symptomatic epilepsies.     

Utilidad del electroencefalograma en el manejo de la epilepsia en el Servicio de Urgencias

IntroductionElectroencephalography (EEG) is an essential diagnostic tool in epilepsy. Its use in emergency departments (ED) is usually restricted to the diagnosis and management of non-convulsive status epilepticus (NCSE). However, EDs may also benefit from EEG in the context of other situations in epilepsy.MethodsWe conducted a retrospective observational study using the clinical histories of patients treated at our hospital's ED for epileptic seizures and suspicion of NCSE and undergoing EEG studies in 2015 and 2016. We collected a series of demographic and clinical variables.ResultsOur sample included 87 patients (mean age of 44 years). Epileptic seizures constituted the most common reason for consultation: 59.8% due to the first episode of epileptic seizures (FES), 27.6% due to recurrence, and 12.6% due to suspected NCSE. Interictal epileptiform discharges (IED) were observed in 38.4% of patients reporting FES and in 33.3% of those with a known diagnosis of epilepsy. NCSE was confirmed by EEG in 36.4% of all cases of suspected NCSE. Presence of IED led to administration of or changes in long-term treatment in 59.8% of the patients.ConclusionsEEG is a useful tool for seizure management in EDs, not only for severe, sudden-onset clinical situations such as NCSE but also for diagnosis in cases of non-affiliated epilepsy and in patients experiencing the first episode of epilepsy.     

Panayiotopoulos syndrome: A case series from Turkey

The aim of the study was to evaluate the demographic, clinical, and EEG characteristics of patients with Panayiotopoulos syndrome (PS) and the course of their illness.Thirty-eight patients followed up with a diagnosis of PS between January 2011 and December 2013 were evaluated.We found high rates of personal history of febrile convulsions, breath-holding spells, and family history of febrile convulsions, afebrile convulsion/epilepsy, migraine, and breath-holding spells. Seizures started before the age of eight in 87% of the patients, and the mean age at seizure onset was 4.6 years. Seizures were sleep-related in 81.5%, and autonomic status was seen in a third of the patients. The number of seizures was between 2 and 10 in 66% of the patients. The most common symptoms were ictus emeticus, eye/head deviation, and altered consciousness. Rolandic features were seen in 26% of the patients, and visual symptoms in 5%. Multifocal epileptiform discharges on EEG were identified in 84% of the patients. Two or more antiepileptic drugs were required in only 13% of the patients. Evolution to electrical status epilepticus in sleep and Gastaut-type epilepsy were seen in patients with more than ten seizures.The high rates of febrile convulsions, afebrile convulsions/epilepsy, migraine, and breath-holding spells in the patients and families suggest the importance of genetic factors and, perhaps, a common pathogenesis. However, the high rates of febrile convulsions and breath-holding spells in patients can be related to a misdiagnosis because of the similar symptoms. Despite its disturbing symptoms, PS is a benign epileptic syndrome requiring multiple antiepileptic drug use only in a small proportion of patients.