分析脑电图在头痛型癫痫诊断中的临床应用

目的分析脑电图在头痛型癫痫检查诊断中的临床应用。方法选取我院2011-01-2014-01收治的头痛型癫痫患者48例为研究对象,采用脑电仪对其进行扫描,对其脑电图的波形变化进行观察分析。结果所有患者中轻度异常18例(37.5%),异常30例(62.5%),其中11例脑电图表现为阵发高幅1~3c/s及4~7c/s慢波节律,且两侧对称同步出现,7例脑电图表现为局限在两额部或前头部的波幅;异常脑电图患者中8例为阵发高波幅慢节奏,且两侧对称性同步出现;15例为阵发尖波棘波、尖慢波或棘慢波综合波幅;5例为散发性棘波或棘2慢波;2例为局限性尖波或棘波。结论采用脑电图对头痛型癫痫进行临床诊断具有非常重要的应用价值。     

头痛间隙期伴癎性放电15例患儿的脑电图分析

目的:分析以"发作性头痛"为主诉的患儿其脑电图癎性放电部位的分布特点。方法:收集中国医科大学附属第一医院儿科门诊101例以"发作性头痛"为主诉的患儿,行脑电图检查。其中15例患儿脑电图中显示癎性放电,对癎性放电的出现部位进行分析。结果:15例患儿中有12例患儿脑电图中的癎性放电表现为散在性棘慢波,且颞叶出现率最高,为65.5%;2例患儿脑电图中的癎性放电表现为全部导联周期性及阵发性棘慢波;1例患儿脑电图中的癎性放电表现为双侧顶枕导联阵发性棘慢波。结论:头痛患者行脑电图检查十分必要,儿童患者的头痛症状应引起临床医生的重视。     

脑囊虫病人头痛发作的病因、临床表现及脑电图分析

目的探讨脑囊虫病人头痛发作的病因、临床特点及脑电图特征。方法对410例脑囊虫病人头痛发作的病因、临床表现、分型及脑电图资料进行统计分析。结果410例脑囊虫病人头痛发作的病因为颅内压增高和脑膜炎。以青壮年为主(72.20%),男性多于女性,农民发病率最高(73.66%)。脑室型头痛(9.51%)以发作性为特点,伴有Brun’s征;脑膜型头痛(9.02%)以持续性头痛为特点,伴有发热;脑实质型头痛(62.93%)以颅压高性或非颅压高性头痛为特点;混合型头痛以颅压高性为特点。脑电图检查正常87例(21.22%),异常323例(78.78%)。异常脑电图中207例(64.09%)主要表现为弥漫性慢波活动,116例(35.91%)为局限性慢波活动,27例在异常背景上有散在或阵发性棘、尖波或棘、尖慢综合波。结论头痛是脑囊虫病人常见症状,颅内压增高和脑膜炎是导致头痛的主要原因;脑电图表现以弥漫性或局限性慢波活动为主。     

中央-颞部棘波的临床价值

目的 探讨脑电图出现的阵发性中央-颞部棘波的临床价值。方法 观察38例脑电图表现为中央-颞部局限性棘波且并非仅表现为中央沟发作患儿的临床发生经过及脑电图表现的变化。其中28例以局限性运动性发作为主,4例表现为不固定的单侧或双侧发作性头痛;2例于5岁前因发热而出现双侧肢体抽搐;余4例无神经系统病症。患儿首次接受脑电图检查的年龄为4～9岁,随访4～7年。结果38例患儿中,癫痫发作者的临床类型呈多种形式;而无癫痫发作病史者中,既有头痛、头晕主诉者,亦有无神经系统疾病病史者。所有患儿的脑电图均表现为不恒定,多次复查脑电图可出现不同部位的局限性慢波或尖波等内容。结论 中央-颞部局限性棘波并非伴中央-颞部棘波的儿童期良性癫痫的特异性脑电图表现。     

中央－颞部棘波的临床价值

目的：探讨脑电图出现的阵发性中央-颞部棘波的临床价值。方法：观察38例脑电图表现为中央-颞部局限性棘波且并非仅表现为中央沟发作患儿的临床发生经过及脑电图表现的变化，其中28例以局限性运动发作为主， 4例表现为不固定的单侧或双侧发作性头痛，2例于5岁前因发热而出现双侧肢体抽搐；余4例无神经系统病症。患儿首次接受脑电图检查的年龄为4-9岁，随访4-7年。结果：38例患儿中，癫痫发作的临床类型呈多种形式；而无癫痫发作病史中，既有头痛、头晕主诉，亦有无神经系统疾病病史。所有患儿的脑电图均表现为不恒定，多次复查脑电图可出现不同部位的局限性慢波或尖波等内容。结论：中央-颞部局限性棘波并非伴中央-颞部棘波的儿童期良性癫痫的特异性脑电图表现。     

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。     

丙戊酸钠引起固定性红斑型皮疹1例报告

患儿,女,10岁,1981年2月起,无明显诱因出现阵发性四肢抽搐,神志丧失,每次2～5分钟,每周3～5次。一般体检和神经系统检查无异常。脑电图描记:各脑区出现阵发性弥漫性高～极高电位、4～6c/s 0活动,伴尖波、棘波、尖-慢、棘-慢综合波发放。诊断癫痫。给以两戊酸钠0.1g,一日三次。7     

脑电图对手足口病脑炎诊断及预后评估的价值

目的 探讨脑电图对手足口病脑炎的诊断及预后评估的价值.方法 对临床确诊的25例手足口病合并脑炎患儿进行脑电图观察.结果 首次脑电图异常率100%.临床症状较重者,脑电图异常程度高,预后差.临床症状较轻者,脑电图异常程度低,预后好.脑电图有阵发性慢活动并有棘、尖波及棘(尖)慢综合波者,癫后遗症的可能性大.结论 脑电图对手足口病脑炎的早期诊断及预后评估有意义.     

儿童良性癫痫伴枕叶爆发

儿童良性癫痫伴枕叶爆发是一种特发性、良性、与年龄和部位相关的癫痫综合征,主要表现为起源于枕叶的视觉症状、眼偏转发作和发作间期脑电图枕区反复阵发假节律性的高波幅棘波、棘慢综合波、尖波、尖慢综合波等癫痫波发放。临床分为早发型(Panayiotopoulos型)、晚发型(Gastaut型)及未定型。临床诊断和分型与其症状学特点有着密切的关系。     

毫针蝶骨电极在癫痫诊断中的应用

目的探讨毫针蝶骨电极在癫痫诊断中的应用价值及常规脑电图加用蝶骨电极的指征。方法102例临床诊断为癫痫的患者于发作间期行常规脑电图及毫针蝶骨电极脑电图描记,分别对其癫痫波的检出率进行分析。结果经χ2检验分析,蝶骨电极脑电图可提高全身强直-阵挛发作、单纯部分性发作、复杂部分性发作3种发作类型癫痫的痫样放电检出率,其中以复杂部分性癫痫尤为显著;此外发现43例常规脑电图描记时耳垂单极导联可见单侧或双侧正相尖（棘）波或正相尖（棘）慢波,而在蝶骨电极描记时均记录到明显的癫痫波。结论蝶骨电极可提高癫痫患者的痫样放电检出率,常规脑电图描记发现耳垂单极导联出现正相尖（棘）波或正相棘（尖）慢波,加用蝶骨电极多可记录到典型的癫痫波,具有临床确诊价值,应列为临床脑电图的常规描记方法。     

儿童头痛性癫痫诊断问题的探讨

目的探讨头痛性癫痫的诊断及与偏头痛的鉴别诊断。方法分析由院外诊断为头痛性癫痫的１０２例患者的临床资料,详细询问病史,进行仔细的体格检查,复查ＥＥＧ１～３次后,重新确定诊断,实施治疗并进行临床随访。结果１０２例患者中,６８例为偏头痛,３４例为神经性头痛。复查ＥＥＧ结果显示大部分在正常范围,部分异常ＥＥＧ中以弥散性慢波增多为主,仅有３例ＥＥＧ显示有散在癫痫样波,但临床表现却符合典型偏头痛的诊断。结论头痛性癫痫临床少见,单纯以头痛诊断为癫痫是不可靠的,必须依靠临床表现、ＥＥＧ检查结果综合判断,并和偏头痛进行鉴别。以头痛为主诉的儿童不应轻易诊断为癫痫。     

Headache originating front-orbital area]

Headache originating front-orbital area can be divided to (1) Which has no autonomic symptoms such as lacrimation, rhinorrea, rhinostasis. This include psychogenic headache and epileptic headache. In the case of psychogenic headache, pericranial tenderness is not observed, and headache is medium in intensity. Most often patient complains of a headache originating frontal area. There are more than five various symptoms such as general malaise, numbness, tingling sensation, vertigo, sleeplessness. However, although symptoms are multiple, patients spend a life commonly. In other words, a patient is protected by a headache against his or her stress. No medication is needed in such a case. In epileptic headache, pressing type pain is felt over the forehead for several minutes to a few hours. Tremor or convulsion sometimes follow the headache. EEG shows spike and wave activities. In the case of focal epilepsy, headache occurs contralateral to the focus. Anti-epileptic drugs such as VPA or CBZ is a choice in such case, and headache as well as seizure disappears. (2) Front-orbital headache with autonomic symptoms include various trigeminal autonomic cephalalgias. These include cluster headache, episodic paroxysmal hemicrania, hemicrania continua, among others. Precise history taking is necessary for the treatment, because no drug is 100% effective.     

Autonomic seizures in 18q- syndrome

The 18q- syndrome is due to (terminal) deletion in the long arm of chromosome 18 with variable break points. The phenotype is also variable, with a variety of dysmorphisms, neurological deficits possibly related to haploinsufficiency of the gene for myelin basic protein, and frequent cardiac problems. The diagnosis of paroxysmal events in 18q- syndrome presents difficulties because both epileptic seizures and cardiac syncopes might be expected to occur. Autonomic seizures are epileptic seizures consisting of episodic alterations of autonomic function that are elicited by activation of autonomic cortical centres. In such events confusion with syncope is even more likely. A previous case of autonomic seizures masquerading as syncope in an adult has been reported. The present report is the first to describe autonomic seizures in 18q- syndrome in a child. Very frequent episodes of prolonged apnoea with profound oxygen desaturation was associated with a focal EEG discharge, arising from either the right temporal or left temporal region. As in the adult patient referred to, the seizures ceased on carbamazepine. No systematic studies of incidence have been published, but autonomic epileptic seizures simulating non-epileptic syncopes may be a feature of 18q- syndrome.     

儿童非癫痫性发作事件的临床与动态脑电监测

目的：探讨24小时动态脑电监测对儿童非癫痫性发作事件的诊断价值。方法：应用24小时动态脑电监测对133例儿童非癫痫性发作事件（惊厥、头痛、晕厥、夜惊和夜游症）进行跟踪监测,分析各时态脑电活动情况。结果：非特异性异常（25％）：惊厥12例（34％）,头痛11例（33％）,李厥5例（21％）,夜惊4例（17％）,夜游症2例（11％）。痫样放电13（10%）：惊厥5例（14）,头痛2例（6％）,晕厥3例（12％）,夜惊2例（9％）,夜游症1例（6％）。非特异性异常和痫样放电检出率以小儿惊厥最高。结论：24小时动态脑电监测有助于儿童非癫痫性发作事件的诊断和鉴别诊断。     

Clinical trials of carbamazepine for autonomic seizures with and without generalized epileptic seizures

Carbamazepine (CBZ) was used for the treatment of 52 children of autonomic seizures with and without generalized epileptic seizures. Their ages ranged from 4 to 17 years. Their autonomic seizures were recurrent episodic headaches and/or abdominal pains. EEG abnormalities were found in all cases in this study. The abnormal EEG findings consisted of diffuse paroxysmal slow dysrhythmia, generalized spike and wave complexes, focal spike and wave complexes with diffuse slow wave bursts, spike and wave complexes with 14 and 6 Hz positive spikes of 14 and 6 Hz positive spikes. Of the 40 patients with autonomic seizures only, 36 (90%) showed disappearance of pain, and of the remaining 4, 2 showed moderate improvement and 2 showed no change as far as their clinical symptoms were concerned. Of the 12 patients with both autonomic seizures and generalized epileptic seizures, 10 (83%) became free from headache and 2 improved moderately. The efficacy of CBZ was found to be very satisfactory. The effective dosage of CBZ ranged from 3.9 to 11.4 mg/kg/day (total dose, 100 to 400 mg/day) with the mean value of 7.0 mg/kg/day.     

Trigeminal autonomic cephalgias: diagnosis, therapy, atypical forms and pathophysiology

Trigeminal autonomic cephalgias; cluster headache, paroxysmal hemicrania, hemicrania continua and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjuctival injection and tearing) syndrome are characterized by unilateral trigeminal distribution of pain and accompanying ipsilateral autonomic symptoms. Other than cluster headache, all of these syndromes have been described within last twenty years, and are found relatively less frequent and less known forms. Diagnosis of paroxysmal hemicrania and hemicrania continua, especially atypical forms, essentially depends on indomethacin responsiveness. For SUNCT syndrome, there is not such a drug which provides a practical approach to both diagnosis and therapy and its diagnosis depends on clinical features. So far, case reports from various countries helped us realize the existence of secondary forms of these syndromes and the necessity of imaging techniques, especially for recently described autonomic cephalgias.     

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.     

Epileptic seizures and headache/migraine: A review of types of association and terminology

PurposeThere are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure (“migralepsy”), 2. hemicrania epileptica, and 3. post-ictal headache.MethodsWe performed an extensive review of the literature, not including “post-ictal” and “inter-ictal” headaches.ResultsOn the basis of well-documented reports, the following clinical entities may be identified: (A) “epileptic headache (EH)” or “ictal epileptic headache (IEH)”: in this condition headache (with or without migrainous features) is an epileptic manifestation per se, with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from “pure” or “isolated” EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). “Hemicrania epileptica” (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) “Pre-ictal migraine” and “pre-ictal headache”: when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role (“migraine-triggered seizure”) is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term “migralepsy” has not been used uniformly, and may therefore led to misinterpretation.ConclusionsOn the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures.     

Value of long-term electroencephalogram in diagnosing epilepsy

BACKGROUND: Routine electroencephalogram (EEG) usually cannot accurately reflect the discharge of epileptic patients due to the short examination, and long-term EEG can make up the shortcoming. OBJECTIVE: To comparatively analyze the long-term EEG of epileptic and non-epileptic patients, and investigate the values of long-term EEG in the diagnosis and differential diagnosis of epilepsy. DESIGN: A case-controlled study. SETTING: Ningjin County People's Hospital. PARTICIPANTS: Totally 122 patients with epilepsy (epilepsy group) were selected from the EEG room of Ningjin County People's Hospital from January 2000 to December 2006, including 76 males and 44 females, 7 months to 78 years of age, the disease course ranged from 7 days to 7.5 years, and they all according with the standards for epilepsy set by the International Association for Epilepsy in 1997. Meanwhile, 118 patients with non-epileptic paroxysmal diseases were selected as the control group, including 71 males and 47 females, 2.5–87 years of age, the disease course ranged from 3 days to 7.5 years. Informed contents were obtained from all the subjects. METHODS: OXFORD GATE WAY 2000 16-lead portable EEG recorder was used for 24-hour electroencephalographic procedure. The patients could move normally during the monitoring, their activities, sleeping conditions, time and manifestations of seizures were recorded in details. In the next day, EEG at wake was recorded for 10 minutes, followed by 3-minute hyperventilation and open/close eye induction test, the phases of non-rapid eye movement (Ⅰ–Ⅳ) and rapid eye movement were performed using EEG at sleep according to the international EEG standard. The abnormal rates of EEG epileptic discharge at wake and sleep at different sites were calculated. MAIN OUTCOME MEASURES: Abnormal rate of long-term EEG at wake and sleep in both groups; Epileptic discharge at different sleeping phases in both groups; Abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group. RESULTS: All the 122 patients with epilepsy and 118 patients with paroxysmal diseases were involved in the final analysis of results. ① Comparison of abnormal rate of long-term EEG at wake and sleep: In the epilepsy group, the abnormal rate of EEG at wake was obviously lower than that at sleep (68%, 91%, P < 0.01). In the control group, the abnormal rate of EEG at wake and sleep had no obvious difference (P > 0.05). ② Results of epileptic discharge at different sleeping phases: In the epilepsy group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 88.1%, and at Ⅲ–Ⅳ in 11.9%; In the control group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 91.7%, and at Ⅲ–Ⅳ phases in 8.3% (1/12). ③ Comparison of the abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group: The abnormal rates of epileptic discharge at frontal lobe and temporal lobe at sleep were obviously higher than those at wake (21.3%, 24.6%; 10.7%, 11.7%, P < 0.01), while there were no obvious differences at wake and sleep at occipital lobe, parietal lobe (P > 0.05). CONCLUSION: Long-term EEG has great importance in the diagnosis and differential diagnosis of epilepsy, especially that it increases the detective rate of discharge by several cycles of sleep derivation. This method also provides important reference for the allocation of epileptic focus.     

Short-lasting primary headaches: focus on trigeminal automatic cephalgias and indomethacin-sensitive headaches

Short-lasting primary headache syndromes provides both a diagnostic challenge and considerable therapeutic reward. Primary short-lasting headaches broadly divide themselves into those associated with auto nomic symptoms, trigeminalautonomic cephalgias and those with little autonomic syndromes. The trigeminal-autonomic cephalgias include cluster headache and paroxysmal hemicranias, in which head pain and cranial autonomic symptoms are prominent. Consideration of short- lasting headaches, particularly in the context of the differential diagnosis between cluster headache and paroxysmal hemicrania leads to a consideration of indomethacin-sensitive headaches. There are a group of headaches, such as paroxysmal hemicrania and hemicrana continua , which have a curious and a very robust response to indomethacin. These headaches tend to be referred to neurologists as they are refractory to other treatments and thus are useful to know about.