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。     

动态脑电图对癫痫的诊断价值

目的探讨动态脑电图(ambulatory electroencephalogram,AEEG)对癫痫(epilepsy,EP)的诊断价值。方法应用奥地利EMS16道脑电记录仪对54例临床诊断为癫痫(常规脑电图均未发现痫样放电)的患者,进行动态脑电图监测。结果①经AEEG检查有痫样放电者44例,阳性率81.5%;②有临床发作者37例(68.5%),其中30例(55.6%)同时出现痫性放电;3例(5.6%)发作期无痫样放电,发作间期脑电图显示痫样放电;4例(7.4%)发作期和发作间期均没有痫样放电;③17例(31.5%)未监测到临床发作,其中11例(20.3%)有痫样放电;6例(1.1%)无痫样放电。结论AEEG监测对癫痫的诊断具有重要价值。     

长程视频脑电图在癫癇诊断与鉴别诊断中的作用

目的评价长程视频脑电图对癫癇和非癫癇发作性疾病的诊断价值。方法对因发作性事件就诊并拟诊为癫癇或可疑癫癇的279例患者的长程视频脑电图资料进行回顾分析。结果 279例患者中122例(43.73%)长程视频脑电图监测到临床发作,其中84例可见发作期同步样放电而确诊为癫癇发作,38例发作期无同步样放电而确诊为非癫癇发作;157例(56.27%)未监测到临床发作,其中102例可见发作间期样放电。监测到发作期或发作间期样放电的188例患者中97例明确癫癇发作类型,其中75例进一步确定为癫癇综合征。结论长程视频脑电图在癫癇的诊断、分型及其与非癫癇发作性疾病的鉴别诊断中具有重要临床价值。     

视频脑电图监测对脑瘫合并癫痫发作性患儿的早期诊断及预后价值

目的分析视频脑电图监测对脑瘫合并癫痫发作性患儿的早期诊断及预后价值。方法回顾性分析62例脑瘫合并癫痫发作性患儿的临床资料,作为观察组;另选同期的62例脑瘫合并非癫痫发作性患儿作为对照组;所选患儿均采取视频脑电图监测,比较观察组和对照组患儿视频脑电图的痫样放电发生率,比较观察组与对照组患儿视频脑电图的同步节律放电发生率,并分析脑瘫合并癫痫发作性与视频脑电图异常放电的关系。结果观察组患儿视频脑电图的痫样放电发生率为79.03%,大于对照组(33.87%),差异具有统计学意义(P0.05);观察组患儿视频脑电图的同步节律放电发生率为66.13%,大于对照组的4.84%;差异具有统计学意义(P0.05);观察组视频脑电图显示发作期痫样放电发生率为64.52%,发作间期痫样放电发生率为41.94%,差异具有统计学意义(P0.05)。结论视频脑电图监测可显著提高脑瘫合并癫痫发作性患儿的痫样放电检出率,在临床发作的同时显示脑电图,分析其特征性变化,均有利于脑瘫合并癫痫发作性的早期诊断及预后评估。     

835例癫痫及发作性疾病动态脑电图分析

目的分析癫痫及发作性疾病患者的动态脑电图(ambulatory EEG monitoring,AEEG),探讨其在诊断和鉴别诊断的中的价值。方法对2010年7月~2014年6月间,本院住院、门诊中临床诊断为癫痫475例及发作性疾病360例患者进行动态脑电图监测并分析。结果癫痫组动态脑电图(AEEG)与常规脑电图(routing-EEG,REEG)比较痫样放电检出率和异常率均有显著差异(P0.01)。癫痫组与发作性疾病组比较痫样放电检出率和异常率均有显著差异(P0.01)。痫样放电多见于睡眠期,以非快速眼动睡眠Ⅰ-Ⅱ期(NREMⅠ-Ⅱ期)为主。在脑电图记录过程中,癫痫组有临床发作36例:5例仅在发作期可见痫样放电,发作间期未见痫样放电;31例两期均可见痫样放电。发作性疾病组有临床发作44例:2例仅发作期可见痫样放电,发作间期未见痫样放电;4例两期均可见痫样放电;其余均未见痫样放电,占86.4%。结论癫痫及发作性疾病患者AEEG检查痫样放电检出率优于REEG检查;在临床症状类似癫痫的发作性疾病中,AEEG及REEG痫样放电检出率只为8.6%及3.6%。因此,发作性疾病需要行AEEG检查,帮助鉴别诊断和确诊。     

SEEG监测对癫痫的诊断及鉴别诊断的价值

目的 探讨睡眠脑电图(SEEG)监测对癫痫及可疑癫痫患者诊断和鉴别诊断的临床价值.方法 对2006年3月～2007年6月间,在本院常规进行视频脑电图描记,其中清醒期脑电图(EEG)无痫样放电的183例临床诊断为癫痫、及52例可疑癫痫患者的SEEG资料进行回顾性分析.结果 癫痫组SEEG痫样放电检出率为84.7%(155/183),可疑癫痫组痫样放电检出率为34.6%(18/52).82.1%的痫样放电出现在睡眠I和II期.结论 SEEG监测可显著提高痫样放电的检出率,为癫痫的诊断及鉴别诊断提供重要依据,并有助于癫痫发作类型的分型.     

非癫痫发作患儿120例视频脑电图诊断分析

目的：对120例非癫痫发作儿童视频脑电图结果进行分析,为该类疾病的诊断提供参考。方法选取2012-10-2014-04于昆明市儿童医院神经内科行视频脑电图检查的1305例患儿中,有临床发作,但发作期同步脑电图正常,未见癫痫放电的120例非痫样发作患儿进行分析。结果行视频脑电图检查的1305例患儿中,有临床发作,但发作期同步脑电图正常,未见癫痫放电的非痫样发作患儿120例。其中N ES合并癫痫12例,7例无癫痫病史也无发作时癫痫样放电,但存在与临床不同步的非发作期的颠痫样放电。结论癫痫性发作及非癫痫性发作治疗原则不同,临床上必须正确判断,通过V-EEG可仔细分析发作时临床表现其与EEG的关系,可对发作性质作出准确判断,为临床治疗提供依据。     

颅内电极监测对顽固性颞叶癫痫致痫灶的定位价值

目的:探讨发作期及发作间期颅内电极监测对癫痫灶的定位作用。方法:20例难治性颞叶癫痫,经临床、影像学及头皮脑电图不能确定致痫灶部位,应用立体定向技术,在患者双侧颞叶植入硬膜下条状电极,进行长时间视频脑电图监测,记录发作期和发作间期的脑电图变化,并与头皮脑电图、MRI进行比较,分析癫痫灶部位,进行手术治疗,术后跟踪随访,评估致痫灶定位的准确性。结果:20例癫痫病人颅内电极埋藏时间1～5天,每个患者至少监测到2次临床发作,每一病例均记录发作间期和发作期的异常放电活动。15例发作间期与发作期定侧一致,2例发作间期为双侧棘波病灶,3例发作间期定位与发作期不一致。按Engel术后效果分级:手术效果满意(癫痫发作消失)13例(65%),显著改善3例(15%),良好3例(15%),无效1例(5%)。所有病例均未出现因颅内电极埋藏而致的并发症。结论:对于致痫灶不能定位的难治性癫痫,应用颅内电极记录方法,尤其是发作期起始时脑电图变化,可以确定致痫灶位置,为癫痫手术治疗提供可靠的依据。     

114例特发性夜间额叶癫痫的临床及脑电图研究

目的 分析114例特发性夜间额叶癫痫(NFLE)患者的临床特征、脑电图和神经影像学表现、治疗效果及预后.方法 回顾性分析解放军总医院癫痫门诊自1999年6月至2007年1月收治的114例NFLE患者的临床资料.结果 NFLE以夜间成串的偏转性、姿势性强直及过度运动发作为最显著的临床特征;本组22.9%清醒发作间期常规脑电图及28%清醒发作间期动态脑电图可见额叶癫痫样放电,38%睡眠发作间期动态脑电图可见额叶癫痫样放电,66.7%发作期脑电图可见额叶癫痫样放电;79.8%药物治疗有效,其中29.7%可完全控制.结论 NTLE具有特征性的临床发作特点,发作期及发作间期脑电图改变阳性率不高,临床上应注意鉴别.额叶癫痫容易在夜间发作,睡眠腩电图对NFLE具有重要的诊断价值.     

75例额叶癫痫的临床特点及发作期发作间期脑电图分析

目的回顾性分析额叶癫痫(FLE)的临床及发作期和发作间期脑电图特点,为临床早期识别和治疗提供依据。方法详细整理75例FLE患者的临床资料,发作期及发作间期脑电图改变和影像学表现,并进行总结分析。结果 (1)临床表现:一种发作类型25例(33%);两种或两种以上发作类型50例(67%);发作时意识清醒者20例(27%);丛集性发作27例(36%);夜间发作36例(48%)。(2)脑电图表现:1发作间期脑电:50例FLE行长程视频脑电监测中异常者47例(94%);2发作期脑电:监测到临床发作22例;3睡眠期痫性放电阳性率高于清醒期(P0.01)。(3)影像学表现:影像学检查异常且病灶位于额叶者36例(54%);非额叶病灶者5例(7.6%);神经影像学未见异常者25例(33%)。结论 FLE临床表现复杂多样,运动症状常见;意识恢复快,多无发作后状态;FLE多于夜间发作,发作时间短暂,呈丛集性发作;FLE脑电图特异性差,长程视频脑电较普通脑电易于检测出痫性放电,睡眠期脑电图阳性率高于清醒期;FLE脑电显示多无侧别提示。     

Bilateral mesial temporal lobe epilepsy: comparison of scalp EEG and hippocampal MRI-T2 relaxometry

OBJECTIVE: Bilateral hippocampal abnormality is frequent in mesial temporal lobe sclerosis and might affect outcome in epilepsy surgery. The objective of this study was to compare the lateralization of interictal and ictal scalp EEG with MRI T2 relaxometry. MATERIAL AND METHODS: Forty-nine consecutive patients with intractable mesial temporal lobe epilepsy (MTLE) were studied with scalp EEG/video monitoring and MRI T2 relaxometry. RESULTS: Bilateral prolongation of hippocampal T2 time was significantly associated with following bitemporal scalp EEG changes: (i) in ictal EEG left and right temporal EEG seizure onsets in different seizures, or, after regionalized EEG onset, evolution of an independent ictal EEG over the contralateral temporal lobe (left and right temporal asynchronous frequencies or lateralization switch; P = 0.002); (ii) in interictal EEG both left and right temporal interictal slowing (P = 0.007). Bitemporal T2 changes were not, however, associated with bitemporal interictal epileptiform discharges (IED). Lateralization of bilateral asymmetric or unilateral abnormal T2 findings were associated with initial regionalization of the ictal EEG in all but one patient (P < 0.005), with lateralization of IED in all patients (P < 0.005), and with scalp EEG slowing in 28 (82,4%) of 34 patients (P = 0.007). CONCLUSION: Our data suggest that EEG seizure propagation is more closely related to hippocampal T2 abnormalities than IED. Interictal and ictal scalp EEG, including the recognition of ictal propagation patterns, and MRI T2 relaxometry can help to identify patients with bitemporal damage in MTLE. Further studies are needed to estimate the impact of bilateral EEG and MRI abnormal findings on the surgical outcome.     

Use of cavernous sinus EEG in the detection of seizure onset and spread in mesial temporal lobe epilepsy

PURPOSE: The study goal was to evaluate the clinical usefulness of intravenous EEG recording by placing wire electrodes in the cavernous sinus (CS) and the superior petrosal sinus (SPS) in patients with intractable temporal lobe epilepsy (TLE), with special emphasis on the ictal recording. METHODS: We placed Seeker Lite-10 guide wire as electrodes in the bilateral CS, SPS, or both to simultaneously record both ictal and interictal EEGs with the scalp EEG in five patients with TLE. In addition, in one patient, we averaged interictal scalp and intravascular EEG time-locked to the epileptiform discharge recorded from the CS/SPS-EEG to further delineate the relationship of the spikes between scalp and intravenous recording. RESULTS: In four of five patients, clinically useful recording was obtained to determine ictal focus. We recorded habitual seizures in three patients, and the detailed characteristics of ictal epileptiform discharges were shown. The averaged waveform of interictal epileptiform discharges clarified the spike distribution in the scalp EEGs, which was otherwise undetectable in the single trace. All of the patients completed the intravenous EEG monitoring without any neurological or psychological problems. CONCLUSIONS: The CS/SPS-EEG is a relatively noninvasive method that is useful for the detection of ictal focus and its spreading pattern and thus for the selection of surgical candidate among patients with intractable TLE. Although the number of seizures detected during the short monitoring period may be limited, due to the advantages of its safety and simplicity, it is worth trying for potential surgical candidates before more invasive examinations are applied. A further study with a larger number of patients is needed to estimate its practical risk.     

EEG of partial seizures.

EEG remains the primary technique in the diagnosis, characterization, and localization of partial seizures. This review examines the significance and character of interictal epileptiform abnormalities, periodic lateralized epileptiform discharges, and ictal patterns in patients with partial epilepsy. Interictal epileptiform discharges are common and assist in the diagnosis and localization of partial seizures. Fortunately, true "false positive" EEGs with focal epileptiform abnormalities are distinctly rare. Periodic lateralized discharges have characteristics of both interictal and ictal activity and are an area of controversy as to their clinical significance. Ictal patterns in partial seizures are variable, with the most distinctive features seen in seizures from a mesial temporal lobe origin. The unifying EEG feature of a partial seizure is in its evolution. A partial seizure begins with a clear delineation of the onset of activity that is distinct from the preceding background, followed by an evolution of this activity in both frequency and amplitude and terminating with an identifiable cessation of the rhythmic pattern that merges again into the background activity.     

Spike frequency is dependent on epilepsy duration and seizure frequency in temporal lobe epilepsy.

OBJECTIVES: We wanted to investigate factors that are associated with frequency of interictal epileptiform discharges by investigating 303 patients with temporal lobe epilepsy (TLE). METHODS: We included all patients who consecutively underwent the adult presurgical evaluation program at our center and who had intractable, medial TLE with complex partial seizures due to unilateral medial temporal lobe lesions. The interictal EEG samples were automatically recorded and stored on computer. The location and frequency of interictal epileptiform discharges were assessed by visual analysis of interictal EEG samples of 2-minute duration every hour. RESULTS: There were 303 patients (aged 16-63) who met the inclusion criteria. The median interictal epileptiform discharge frequency was 15 IED/h, the median seizure frequency was 4 seizures/month. According to univariate analyses, we found that age at monitoring, epilepsy duration, and higher seizure frequency were associated with higher interictal epileptiform discharge frequency. In the logistic regression analysis, we found that higher seizure frequency (p < 0.001) and longer epilepsy duration (p = 0.007) were independently associated with higher spike frequency, while the age at monitoring was not. CONCLUSIONS: Seizure frequency and epilepsy duration (years of patient's life with seizure activity) were independently associated with IED frequency, suggesting that IED are modulated by seizures.     

Hyperkinetic seizures in children

The objective of this study was to delineate the clinical and video-electroencephalographic (EEG) manifestations of children with complex partial seizures with a predominant "hyperkinetic" presentation. Certain types of partial seizures can be difficult to differentiate from nonepileptic seizures because of their intense motor presentation and, at times, lack of alteration of consciousness. Based on a published semiologic seizure classification, this type of seizures can be described as "hyperkinetic," characterized by intense motor activity involving the extremities and trunk. We report five children diagnosed with hyperkinetic seizures by video-EEG monitoring. All patients were referred for video-EEG evaluation because of an initial suspicion of pseudoseizures. Presented in this study is a review of the patients' clinical data, including video-EEG evaluation. There were three boys and two girls; the mean age at presentation was 10 +/- 3 years. In four patients, there was a history of behavioral disorder, with two patients carrying a diagnosis of attention-deficit hyperactivity disorder (ADHD). One girl had significant developmental delay and an abnormal neurologic examination. Brain magnetic resonance imaging was normal in three patients and abnormal in two. The semiology of the seizures consisted of stereotypic intense motor activity, mainly upper extremity flailing and kicking. Screaming and shouting were noted in three cases, and intense fear was present in two patients. The hyperkinetic ictal activity progressed to tonic-clonic seizures in two patients. Seizures occurred out of sleep or on awakening in four patients. The interictal EEG activity was normal in one patient and revealed a continuous generalized slowing and slowing of the posterior dominant rhythm in two patients. One of the latter patients had interictal epileptiform activity in the frontal and midline regions. An intermittent rhythmic slow activity of the left hemisphere with superimposed bifrontal sharp waves was noted in the fifth patient. The ictal EEG revealed profuse superimposed electromyographic (EMG) activity in all patients, making some of the EEG interpretation difficult to analyze, particularly a longitudinal bipolar montage. However, with digital manipulation of the ictal EEG data, such as changes in EEG sensitivity, application of fast frequency filters, and use of different EEG montages, it was possible to discern an ictal EEG pattern or postictal slowing following the diffuse EMG artifact in all patients. On clinical follow-up, adequate seizure control was achieved in three patients. Based on the clinical history, one patient was diagnosed with autosomal dominant nocturnal frontal lobe epilepsy. Diagnosis of hyperkinetic seizures can be difficult because of the similarity of the clinical manifestations with nonepileptic events such as certain parasomnias and pseudoseizures. Video-EEG is the most effective way of diagnosing this type of seizure.     

Tooth-brushing epilepsy with ictal orgasms.

We report a 41-year-old woman with complex reflex epilepsy in which seizures were induced exclusively by the act of tooth brushing. All the attacks occurred with a specific sensation of sexual arousal and orgasm-like euphoria that were followed by a period of impairment of consciousness. Ictal EEG demonstrated two events of epileptic seizure that were provoked after tooth brushing for 38 and 14 seconds, respectively. The interictal EEG showed epileptiform discharges over the right anterior temporal region and interictal single photon emission computed tomography (SPECT) scan showed relative hypoperfusion in the uncus of right temporal lobe. Brain magnetic resonance imaging (MRI) revealed right hippocampal atrophy. We suggest that tooth-brushing epilepsy, especially with sexual ictal manifestations, may provide insight into the cerebral pathophysiology at the right temporolimbic structure.     

Interictal, unifocal spikes in refractory extratemporal epilepsy predict ictal origin and postsurgical outcome.

OBJECTIVES: To evaluate the significance of exclusively unifocal, unilateral, interictal epileptiform patterns on scalp electroencephalography (EEG) in surgical candidates with medically intractable extratemporal epilepsy. METHODS: We reviewed 126 patients with refractory extratemporal partial seizures who underwent epilepsy surgery at our center. All were followed for at least 2 years after resections. Surgery was based on ictal EEG recordings. We examined ictal onsets and surgical outcome in subjects whose preoperative, interictal scalp EEGs during long-term monitoring (LTM) demonstrated only unilateral, well-defined focal discharges, and outcome in patients whose interictal EEGs during LTM showed bilateral, non-localized, or multifocal epileptiform patterns. RESULTS: We found that 26 subjects exhibited only unilateral, unifocal, interictal epileptiform patterns. In all 26 cases (100%) clinical seizures arose from the regions expected by the interictal findings (P<0.0001, Sign test). At last follow-up 77% (20/26) of these patients were seizure-free, while 23% (6/26) had >75% reduction in seizures. This compares to the remaining patients, of whom 34% (34/100) were seizure-free, 41% (41/100) had >75% reduction in seizures, and 25% (25/100) had <75% reduction in seizures (P=0.0001, Fisher's Exact test). CONCLUSIONS: Strictly unifocal, interictal epileptiform patterns on scalp EEG, though seen in a minority of subjects, may be an important, independent factor in evaluating subjects with intractable extratemporal, localization-related epilepsy for surgical therapy. This finding is highly predictive of both ictal onsets and successful postsurgical outcome.     

Frontal lobe epilepsy

About one-quarter of patients with refractory focal epilepsies have frontal lobe epilepsy (FLE). The typical seizure semiology for FLE includes unilateral clonic, tonic asymmetric or hypermotor seizures. Interictal electroencephalograms (EEG) usually reveal interictal epileptiform discharges and rhythmical midline theta, which has localizing value. The usefulness of ictal EEG recordings is limited by frequent muscle artifacts in motor seizures and because a large portion of the frontal lobe cortex is “hidden” to scalp electrodes. Ictal single photon emission CT and positron emission tomography are able to localize FLE in about one-third of patients only. A pre-surgical evaluation should include, whenever possible, a subclassification of FLE as dorsolateral frontal, mesial frontal or basal frontal lobe epilepsy to allow a minimal cortical resection. A review of the typical findings of seizure semiology, interictal and ictal EEG regarding the different FLE subtypes is given. Etiology, medical treatment and surgery are also discussed.