癫癎患者认知功能与事件相关电位临床研究进展

癫癎造成的脑损害是多方面的。除临床症状外，常伴有注意力分散，学习能力、记忆力减退，社会适应能力下降等多种认知功能受损的表现。事件相关电位（ERP）的P300成分是反映认知功能比较可靠、灵敏、客观的指标，已广泛应用于脑损害患者认知功能的研究及评价。因此本文对影响癫癎患者认知功能状况的主要因素及与ERP（本文主要指P300）的相互关系的研究作一综述。     

癫癎患者听觉事件相关电位的检测报告

目的:探讨听觉事件相关电位(ERP)在癫癎患者中的应用价值。方法:对40例癫癎患者和30名正常人进行ERP检测比较,并将癫癎患者ERP的结果与其发作类型、用药情况等进行比较分析。结果:40例癫癎患者的ERP P300潜伏期较对照组延长(P<0．05),但其P300波幅差异无统计学意义(P>0．05)。全身强直阵挛性发作的28例癫癎患者,P300潜伏期延长尤著。多药治疗组较单药治疗组P300潜伏期延长。结论:癫癎患者存在认识功能障碍,ERP可作为癫癎患者认知功能障碍诊断的参考指标,对指导临床,及早给予干预和治疗有一定意义。     

癫(癎)儿童事件相关电位P300检测报告

目的:探讨事件相关电位(ERP)的P300成分检测对癫癎儿童认知功能的评价。方法:利用ERP、韦氏儿童智力量表中国修订版(WIS-CR)对32例癫癎儿童进行P300测定和心理评估,以28例性别、年龄相匹配的正常儿童作对照。结果:与正常对照组比较,癫癎组儿童总智商(FIQ)、语言智商(VIQ)和操作智商(PIQ)得分均明显降低(P<0．01),32例癫癎患儿中有28％有智能障碍;ERP的P300波潜伏期也明显延长,P<0．01。结论:癫癎儿童易发生智力障碍,P300波潜伏期检测能早期、客观、准确地评价癫癎儿童的认知功能状况。     

具有中央颞区棘波的良性癫癎患儿与认知功能的相关性研究

目的：研究具有中央颞区棘波的儿童良性癫癎（BECT）患儿的认知功能状态。方法：30例BECT患儿作为患儿组,与其年龄、性别、家庭经济状况及父母受教育程度等方面相匹配的健康儿童30例为对照组。采用韦氏儿童智力量表测定（C—WISC）及事件相关电位（ERP）P300对患儿认知功能进行测定。结果：①患儿组言语智商（VIQ）、知觉组织因子（POF）和记忆／注意不分心因子（MF）均较正常儿童降低,差异有显著意义（均P〈0．01）;②患儿组P300潜伏期均较正常对照组显著延长（P〈0．01）。结论：BECT患儿存在认知功能损害。     

癫癎患者的短潜伏期体感诱发电位与临床相关性的研究

目的：研究癫癎患者短潜伏期体感诱发电位（SLSEP）的变化规律及相互关系,并对SLSEP技术在其中的应用价值进行评价。方法：对癫癎患者在发作间期进行SLSEP检测,以潜伏期为观察指标,检测双侧N20、P40、P15、IN16、N16、N18、N19波潜伏期,并与正常人作对照。结果：癫癎组N20、P15、IN16、N16各波潜伏期较对照组明显延长（P〈0．01）;癫癎患者头颅CT／MRI异常组同侧记录的IN16潜伏期较头颅CT／MRI正常组的IN16波潜伏期延长（P=0．01）;癫癎患者脑电图异常组P15波潜伏期较脑电图正常组的延长（p=0．05）;病程5年以上组P40、P15波潜伏期较1-5年组延长（P=0．00、P=0．01）,病程5年以上组P40波潜伏期较1年以下组延长（P=0．03）;用2种及以上抗癫癎药组IN16波潜伏期较未用抗癫癎药组的明显延长（P=0．01）,用两种及以上抗癫癎药组IN16、N16、N18波潜伏期较用1种抗癫癎药组明显延长（p=0．01、P=0．02、P=0．02）;每月发作两次以上组P40波潜伏期较每月发作两次及以下组明显延长（P=0．04）。结论：癫癎患者存在脑功能障碍,并有相应的SLSEP改变。SLSEP检测技术可以评估癫癎患者的脑功能,并且能够动态观察比较,可对患者的疗效和预后评估提供指导。     

与遗传相关的癫(癎)和癫(癎)综合征

癲(癎)是一组以脑部神经元异常放电所致的、以反复发作为特征的脑部疾患.     

首发精神分裂症女性患者雌激素与事件相关电位的相关性

目的：研究首发精神分裂症女性患者雌激素与事件相关电位（ERP）P300的关系。方法：采用放射免疫法测定30例首发精神分裂症女性患者（患者组）与20名正常女性（对照组）的血清雌激素水平;并用ERPP300（即P3波）评定患者认知功能。结果：①患者组雌二醇（E2）水平低于对照组,差异有统计学意义（P〈0．05）;②与正常对照组比较,患者组靶刺激N1、N2和P3波及非靶刺激P2波潜伏期延迟,靶刺激P3波及非靶刺激P2波波幅降低;③患者组E2水平与P300潜伏期呈显著负相关（r=-0．43,P=0．02）。结论：首发精神分裂症女性患者存在雌激素水平下降,以及注意力、记忆力缺陷和认知加工缓慢等认知障碍,雌激素水平与认知功能呈显著相关。     

事件相关电位与认知功能障碍相关性研究的进展

事件相关电位（Event-Related Potentials,ERP）是一种无损伤的脑认知成像技术,是指与一定心理活动（即事件）相关联的脑电位变化,目前已经成为研究神经科学的一种独特方法,并广泛应用于认知神经科学及临床研究。认知功能障碍严重影响患者的生活品质,人口老龄化使其发病率明显升高,给社会及家庭带来了沉重负担。近年来国内外关于ERP与认知功能障碍的相关性研究很多,本文兹就ERP技术在不同疾病引起的认知功能障碍中的应用作一简述。     

妊娠与癫(癎)

癫(癎)是神经内科的第二大疾病,我国流行病学显示其患病率为0.5％～0.7％,全国约有病人600～700万,其中女性患病率占0.2％～0.3％,约120～210万妇女患者.因有部分女性患者的癫(癎)与妊娠之间会发生明显的相互影响,对该类患者的治疗更为神经科医生的一大棘手问题.     

9例癫(癎)孕妇临床分析

目的:分析妊娠期癫(癎)发作对孕妇及胎儿的影响及处理.方法:分析9例癫(癎)孕妇的病史,记录其妊娠期间发作的变化、服抗癫(癎)药的情况、妊娠结局及胎儿情况.结果:妊娠期间发作频率增加者4例,无发作者2例,发作频率无改变者3例;单药治疗者3例,2例联合治疗,4例未治疗.新生儿中1例巨大儿:1例出生1min Apgar评分为7分,余8例均为9分.结论:生育期癫(癎)妇女应进行孕前咨询,根据发作类型选用适宜的致畸危险性小的抗癫(癎)药物,以单药治疗为原则;妊娠期间定期进行血药浓度的监测并加服叶酸.     

轻度认知障碍患者事件相关电位的诊断价值

目的：对轻度认知障碍（MCI）患者进行事件相关电位（ERP）检测,结合简易智能量表（MMSE）综合评价ERP对MCI的诊断价值。方法：将180例受试者分别编入MCI组、痴呆组及正常对照组,均进行听觉及视觉ERP检测,统计分析各组别ERP的特点。结果：MCI组与正常组及痴呆组比较,P300潜伏期和N2-P3以及P2-P3峰间波幅比较差异均有显著意义（P〈0．01）,其异常出现率也有差异。结论：P300可作为反映认知功能变化和作MCI诊断的一个客观的电生理学指标。     

高血压患者抑制控制加工异常的ERP研究

目的：探讨高血压患者抑制控制缺陷的神经电生理机制。方法：采用视觉事件相关电位（ERP）Go-Nogo实验范式,选取高血压患者14例和正常对照15例进行研究。视觉刺激物为随机出现的等边三角图形,要求被试看到两个三角形（Go刺激）时尽快尽准确地按键,看到一个三角形（Nogo刺激）时不按键。Go刺激和Nogo刺激概率分别为60％、40％,随机呈现,记录行为学数据和32道ERP数据。结果：两组被试的行为学数据比较差异无统计学意义,ERP结果发现：N2d波、P3d波潜伏期高血压组明显高于对照组[N2d：F（1.27）=25．858,P=0．000,P3d：F（1.27）=6．013,P=0．021],差异有统计学意义,Nogo—N2波波幅[F（1.27）=3．391,P=0．077]、潜伏期[F（1.27）=3．783,P=0．062]及N2d波波幅[F（1．27）=2．968,P=0．096]组间差异边缘性显著。P3d波波幅、NogoP3波幅和潜伏期无明显组别差异。结论：高血压患者早期冲突监控机制异常,在200～300ms时间窗内抑制控制加工障碍,为高血压病的进一步研究提供神经电生理依据。     

Simultaneous identification of eye fixation related potentials and reaction related potentials from single-trial signals

To obtain the effective components from event related potentials (ERPs), it has been necessary to average the waveforms of several trials. ERP data reflect the psychophysiological state of a subject. Time variation is an important feature in ERP analysis, and so the single-trial method is required. A method is proposed to identify simultaneously both eye fixation related potentials (EFRPs) and reaction related potentials (RRPs) using wavelength transforms. The EFRP is an ERP associated with saccadic eye movement. The RRP is defined as a component similar to P300 gained from the reaction signal. Six subjects participate in the oddball task. The task takes 30 min for each subject. Electroencephalograms (EEGs), electro-oculograms (EOGs) and electromyograms (EMGs) are simultaneously recorded. The EFRP is extracted for the offset of saccade from EOG, and the RRP is extracted for the onset of reaction from EMG. The results show that the estimated waveforms described well each of the components in the EFRP and RRP. Moreover, the simulation results show that the amplitudes of the lambda wave are estimated to within an error of 4%, and those of the latencies are within 0.4%, with an SNR of 4.5dB. Those of P300 were 11 and 4%, respectively. The reliability of the method is proved to be sufficient for estimating ERPs.     

Fast temporal event integration in the visual domain demonstrated by event‐related potentials

Four experiments are reported that investigated visual event integration by using a variant of the missing element paradigm. Good performance on this task depends on whether two brief successive stimulus displays are perceived as (or integrated into) one single event. We replicated the classic finding of greater accuracy with shorter duration of the first stimulus and ruled out an attention‐related account thereof. In a subsequent electrophysiological experiment we found that successful event integration increased the amplitude of the N1, N2, and late P3 components of the event‐related potential and decreased early P3 amplitude. No effect on the P1 was observed. The results provided evidence for an early onset of event integration in time and demonstrated the existence of electrophysiological markers of episodic integration. The implications of these results are related to studies on feature‐specific integration and early attentional processes.     

A comparative analysis of sensory visual evoked oscillations with visual cognitive event related oscillations in Alzheimer's disease

We compared visual evoked oscillatory responses of subjects with Alzheimer's disease (AD) (n = 22) to healthy elderly controls (n = 19) elicited by simple light stimuli. The visual evoked oscillatory responses in AD subjects without cholinergic treatment (n = 11) show significant differences (df = 2.38, F = 4.957, P = 0.012) from the controls and the AD subjects treated with a cholinesterase inhibitor (n = 11). Higher theta oscillatory responses in untreated AD subjects are seen on the electrode locations over bi-parietal and right occipital regions after simple light stimuli with less, if any, cognitive load. These changes were restricted to the theta frequency range only and are related to location, frequency bands and drug effects. In our previous work we observed that visual event related oscillations elicited after the visual stimuli with a higher cognitive load, i.e. an oddball target, display lower amplitudes: between controls and AD subjects in delta frequency band without a drug effect, over the left and mid-central region. These differences between the visual evoked oscillations and the visual event related oscillations imply that there are at least two different cognitive circuits that are activated upon visual stimuli in AD patients.     

心算实验中事件相关去同步化脑电变化初探

目的：探讨事件刺激处理时心理活动的脑电生理改变。方法：应用脑电地形图的检测技术对３０例正常人安静状态及在两种作业难度下脑电功率值的变化进行观察。结果：①事件刺激后α２频带功率值降低,β、α１频带功率值增高,变化以枕区、顶区、后颞区的功率值最为显著;②随作业难度的增加α２频带功率呈梯度降低,β频带功率则呈梯度增高;③在心算过程中,安静状态下呈现的两侧半球电位值差异消失。结论：心算期间大脑皮层出现事件相关去同步化,并存在区域性差异。更高作业难度将导致更广泛更持久的脑电去同步化     

The impact of driver sleepiness on fixation‐related brain potentials

The effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation‐related lambda response. Thirty young male drivers (23.6 ± 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night‐time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed‐effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation‐related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.     

Phonotactic constraint violations in German grammar are detected automatically in auditory speech processing: a human event-related potentials study

In this human ERP study, effects of language‐specific phonotactic restrictions on automatic auditory speech processing were investigated by means of the dorsal fricative assimilation (DFA) that is obligatory in German grammar. Using a multiple passive oddball paradigm, we studied the deviance‐related processing of phonotactically ill‐formed strings violating DFA. Eight VC‐syllables were created by exhaustively combining the vowels and the dorsal fricatives , resulting in four well‐formed and four ill‐formed stimuli that were contrasted in oddball blocks with changing probabilities of occurrence. Only the ill‐formed deviants elicited a negative ERP deflection maximal at about 100 msec after the onset of the fricative. This negativity is considered to reflect a phonotactic evaluation process requiring the activation of implicit phonotactic knowledge from long‐term memory and resulting in the automatic detection of a DFA violation.     

癫癇患者智能障碍相对选择性的探讨

目的 :探讨癫患者的智能障碍。方法 :对 6 6例癫患者进行韦氏成人智力测验(WAIS RC)和事件相关电位 (ERPP3 0 0 )的测定。结果 :发现癫智能障碍组以算术、相似、填图、木块图、知识等分测验的得分降低较明显。结论 :P3 0 0 潜伏期与填图、数字符号、知识等分测验关系密切。癫患者的智能障碍存在一定程度的选择性。