儿童偏头痛98例临床和脑电图分析

目的探讨儿童偏头痛临床特点和脑电图变化。方法分析本院门诊诊治98例偏头痛患儿临床资料。通过详细询问病史,仔细体格检查及行脑电图(EEG)或视频脑电图(V-EEG)、经颅超声多普勒(TCD)描记,予以诊断、治疗,并进行随访。结果98例患儿中27例为典型偏头痛,71例为普通偏头痛。EEG和V-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1例EEG显示有癫波;而TCD结果显示87例提示脑动脉血流速度不同程度增快。结论儿童偏头痛的临床特点与成人类似,但有其自身特点,采用EEG与TCD结合对其诊断有重大价值,应与癫鉴别。     

视频脑电图在儿童偏头痛与头痛性癫痫鉴别中临床价值

儿童偏头痛在临床上十分常见，发作性头痛或眩晕易被误诊为癫痫。近年来国内有关头痛性癫痫的报道越来越多。为此，我们白1999年以来，对来我院神经科门诊诊治的、由外院诊断为头痛性癫痫并已进行抗癫痫药物治疗的36例患儿，经过详细询问病史、临床检查和视频脑电图(V-EEG)、经颅超声多普勒(TCD)描记，予以诊断、治疗并进行随访，现将结果分析如下。     

儿童偏头痛的临床特点及脑电图表现

目的：探讨偏头痛的临床特点和脑电图表现。方法：对40例诊断偏头痛的患儿进行临床症状、遗传史以及脑电图分析。结果：40例偏头痛患儿均表现为发作性头痛,持续时间最低不少于25 min,部分有视觉先兆;其中22例(占55%)表现为脑电图异常,甚至癫痫样波;部分病例具有明显的家族遗传史。结论：偏头痛是儿童常见的发作性疾病,多数可表现为脑电图异常,甚至癫痫样放电,但不能将脑电图异常代替癫痫临床诊断、使头痛性癫痫扩大化。     

儿童偏头痛与癫痫相关性的研究

目的 探讨儿童偏头痛与癫痫的相关性及鉴别诊断。方法 对32例偏头痛患儿（其中9例并临床癫痫发作）进行脑电图及临床分析。结果 32例中脑电图异常18例，其中14例为偏头痛，异常率为43.75%,4例枕叶癫痫，3例普通型头痛伴癫痫发作，脑电图3次复查正常，2例复杂型偏头痛伴临床癫痫发作，脑电图均表现异常。结论 儿童偏头痛常常表现脑电图非特异性异常，甚至痫样放电，但以脑电图异常不能代替临床诊断，头痛性癫痫的诊断必须结合临床表现和脑电图检查结果综合判定，并与偏头痛进行鉴别。某些偏头痛可以伴癫痫发作，两者交叉重叠。极易混淆，对头痛性癫痫的诊断应慎重。     

视频脑电图在儿童偏头痛与头痛性癫癎鉴别中临床价值

儿童偏头痛在临床上十分常见,发作性头痛或眩晕易被误诊为癫癎.近年来国内有关头痛性癫癎的报道越来越多[1].为此,我们自1999年以来,对来我院神经科门诊诊治的、由外院诊断为头痛性癫癎并已进行抗癫癎药物治疗的36例患儿,经过详细询问病史、临床检查和视频脑电图(V-EEG)、经颅超声多普勒(TCD)描记,予以诊断、治疗并进行随访,现将结果分析如下.     

儿童偏头痛与癫癎相关性的研究

目的　探讨儿童偏头痛与癫的相关性及鉴别诊断。方法　对 32例偏头痛患儿 (其中 9例并临床癫发作 )进行脑电图及临床分析。结果　 32例中脑电图异常 1 8例 ,其中 1 4例为偏头痛 ,异常率为43 .75 % ,4例枕叶癫。 3例普通型头痛伴癫发作 ,脑电图 3次复查正常 ,2例复杂型偏头痛伴临床癫发作 ,脑电图均表现异常。结论　儿童偏头痛常常表现脑电图非特异性异常 ,甚至样放电 ,但以脑电图异常不能代替临床诊断。头痛性癫的诊断必须结合临床表现和脑电图检查结果综合判定 ,并与偏头痛进行鉴别。某些偏头痛可以伴癫发作 ,两者交叉重叠 ,极易混淆。对头痛性癫的诊断应慎重     

早发型良性儿童枕叶癫痫18例脑电图及预后分析

探讨早发型良性儿童枕叶癫痫（EOBCOE）的临床发作形式、痫性放电波形与分布、病理生理特征、临床诊断方法及预后演变规律。方法　对2005年1月至2008年12月重庆医科大学附属儿童医院神经内科诊疗的18例EOBCOE患儿资料进行回顾性临床分析,对其清醒和睡眠脑电图（EEG）资料及治疗随访结果进行研究。结果　18例患儿首次起病年龄2岁2个月至8岁6个月。5例分别有癫痫家族史和（或）热性惊厥家族史,4例有热性惊厥史。EOBCOE具有突出的自主神经性发作及迟后的特殊运动发作症状（面色苍白和发作性呕吐、头眼斜视旋转发作或凝视、继发性部分或全面性发作、自主神经性癫痫持续状态）。2例伴Rolandic 发作。多数1至数月发作1次,个别频繁发作。EEG示13例有枕区或枕区为主局灶或多灶性棘-慢波放电,波形以高幅宽大棘-慢波为主,也可见不典型小尖波,均可被睁眼所抑制。发作期显示枕区或额区为主或全脑节律性棘-慢波活动。患儿对卡马西平、丙戊酸钠和妥泰等疗效较好;发作基本消失11例,明显减轻4例,病情波动2例,猝死1例。EEG痫性放电减轻8例,变化不明显4例,正常5例。除7例有轻度学习困难和行为异常以外,其他患儿神经精神发育基本正常。结论　EOBCOE是一种早期起病的良性儿童枕叶或自主神经性癫痫,具有突出的自主神经性症状,局灶或继发全面性发作或癫痫持续状态等临床特征与其他良性儿童癫痫相关,EEG示枕区或枕外多灶性放电,多数预后良好。     

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目的探讨早发型良性儿童枕叶癫痫(EOBCOE)的临床发作形式、痫性放电波形与分布、病理生理特征、临床诊断方法及预后演变规律。方法对2005年1月至2008年12月重庆医科大学附属儿童医院神经内科诊疗的18例EOBCOE患儿资料进行回顾性临床分析,对其清醒和睡眠脑电图(EEG)资料及治疗随访结果进行研究。结果18例患儿首次起病年龄2岁2个月至8岁6个月。5例分别有癫痫家族史和(或)热性惊厥家族史,4例有热性惊厥史。EOBCOE具有突出的自主神经性发作及迟后的特殊运动发作症状(面色苍白和发作性呕吐、头眼斜视旋转发作或凝视、继发性部分或全面性发作、自主神经性癫痫持续状态)。2例伴Rolandic发作。多数1至数月发作1次,个别频繁发作。EEG示13例有枕区或枕区为主局灶或多灶性棘-慢波放电,波形以高幅宽大棘-慢波为主,也可见不典型小尖波,均可被睁眼所抑制。发作期显示枕区或额区为主或全脑节律性棘-慢波活动。患儿对卡马西平、丙戊酸钠和妥泰等疗效较好;发作基本消失11例,明显减轻4例,病情波动2例,猝死1例。EEG痫性放电减轻8例,变化不明显4例,正常5例。除7例有轻度学习困难和行为异常以外,其他患儿神经精神发育基本正常...     

伴有中央颞区棘波小儿良性癫痫7例临床和脑电图分析

目的：分析伴有中央颞区棘波的小儿良性癫痫(BECT)临床和脑电图(EEG)特点。方法：对7例该病患儿的临床资料和EEG分析。结果：该组发病年龄为3～13岁。7例发病与睡眠密切相关。7例发作间期脑电图均有一侧或双侧中央和(或)中颞区尖波或棘波。结论：伴有中央颞区棘波的小儿良性癫痫临床发作和睡眠密切相关,其以学龄儿为多见,发作间期脑电图均有一侧或双侧中央或(或)中颞区尖波或棘波。     

获得性癫痫性失语1例报告及文献复习

目的 探讨中国人获得性癫痫性失语的临床特征。方法 获得性癫痫性失语1例报告并复习文献，对37例诊断为获得性癫痫性失语患儿进行临床资料分析。结果 获得性癫痫性失语均发作于儿童期，临床均有失语及脑电图癫痫样放电。其中以混合性失语及脑电图棘-慢复合波为多见，多数临床有痫样发作。结论 中国儿童获得性癫痫性失语的痫样发作及失语多数控制良好。     

Electroencephalography in Pediatric Epilepsy

Surface electroencephalography (EEG) is a useful electrophysiological investigation for evaluating a paroxysmal event in children. It measures the electro potential difference between two points on the scalp. It is a non-invasive tool that analyzes neuronal maturation and abnormal cortical excitability. EEG helps in differentiating epileptic from non-epileptic clinical event and focal seizures from generalized seizure. This review is to discuss the rational use of interictal scalp EEG in diagnosis of epilepsy and different types of epilepsy syndromes in children. It further highlights its role in febrile seizure, first unprovoked seizure, status epilepticus and unexplained coma.     

Focal epilepsy with ictal abdominal pain: a case report

Focal epilepsy with ictal abdominal pain is an unusual partial epilepsy characterized by paroxysmal episodes of abdominal or visceral pain, disturbance of awareness and electroencephalographic abnormalities. We describe a new case of ictal abdominal pain in which gastrointestinal complaints were the only manifestation of seizures and review the previously described pediatric patients. In our patient clinical findings, ictal EEG abnormalities, and a good response to antiepileptic drugs allowed us to make a diagnosis of focal epilepsy with ictal abdominal pain. This is a rare epileptic phenomenon that should be suspected in patients with unexplained paroxysmal abdominal pain and migraine-like symptoms. We suggest that, after the exclusion of more common etiologies, focal epilepsy with ictal abdominal pain should be considered in patients with paroxysmal abdominal pain and ictal EEG abnormalities.     

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??Migraine and epilepsy are both common neurological chronic disorders in childhood, which are linked with each other in clinical manifestations, pathogenesis and treatments. Sometimes the variants of migraine are most frequently mistaken for epilepsy. It is necessary to have correct differentiation of epilepsy from headache and proper medical management of epilepsy comorbid with headache in children in order to achieve effective treatment??improve the prognosis of epilepsy children and guarantee the medical security.     

Pitfalls in the diagnosis and misdiagnosis of epilepsy

Epilepsy affects 1 in 200 children in the UK. Appropriate management and prognosis depends on accurate diagnosis. There is no single diagnostic test. Diagnosis is based principally on history of attacks with support from investigations. Misdiagnosis rate is high amongst children, the commonest cause being the lack of awareness of other causes of paroxysmal events in childhood and misinterpretation of EEG findings. A paediatrician with expertise and training in epilepsy, working within a network linked to tertiary Paediatric Neurology, should undertake assessment of children presenting with paroxysmal events.     

The migraine syndrome in children

Migraine is a brain disorder with complex pathogenesis and aetiology. The clinical presentation of migraine changes with brain maturation during the first 20 years of life. Migraine is typically a paroxysmal disorder with well-defined episodes separated by freedom of symptoms. Despite the variable clinical features of migraine, each episode may have a predictable sequence of phases. The main phase of each episode is characterized by one or more symptoms of severe headache, vomiting, abdominal pain, vertigo and/or torticollis. This phase may be preceded by premonitory and aura symptoms, and followed by a recovery phase and resolution of symptoms. These phases can be clear and well defined in some patients but indistinct and subtle in others. Different migraine presentations share common trigger factors, associated symptoms, relieving factors and family history. This review describes migraine as a primary headache disorder, but with greater emphasis on other forms of migraine in children and young people including abdominal migraine (AM), cyclical vomiting syndrome (CVS), benign paroxysmal vertigo (BPV), benign paroxysmal torticollis (BPT) and infantile colic (IC). We will discuss clinical assessment, diagnostic criteria, investigation (when needed) and treatment for each childhood migraine syndrome.     

Differential diagnosis of cerebral seizures]

Several non-epileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy and they must be considered in the differential diagnosis. Some of these disorders are discussed in the present review: vasovagal, vasomotor and cardiac syncopes, breath holding spells. Among the sleep disorders, parasomnias, nightmares and the benign neonatal sleep myoclonus are mentioned. Migraine with aura, alternating hemiplegia and benign vertigo of childhood are probably related disorders. Benign myoclonus of early infancy, paroxysmal choreoathetoses and pseudoepileptic or hysterical seizures are further non-epileptic attack disorders to be considered in the differential diagnosis.     

视频脑电图在睡眠相关发作性疾病中的诊断价值

目的探讨视频脑电图在睡眠相关发作性疾病的诊断与鉴别诊断中的应用价值。方法收集2005年1月～2006年6月在我院儿科病房和门诊就诊的具有与睡眠相关发作性症状患儿65例。其中拟诊癫痫35例,非性发作性疾病30例。全部行常规脑电图（EEG）和视频脑电图（VEEG）检查。结果拟诊癫痫35例,性波阳性率VEEG为62.86%（22/35）,EEG为17.14%（6/35）,有显著性差异（χ^2=15.23P〈0.01）;经EEG监测,结合其临床表现,确诊癫痫27例中,额叶癫痫2例,颞叶癫痫1例,儿童良性癫痫伴中央中颞区棘波7例;VEEG检查其中样放电22例（81.48%）,睡眠期18例（81.82%）,清醒期11例（50%）,睡眠相关性癫痫睡眠期异常放电率高于清醒期（χ^2=4.96P〈0.05）;共监测到发作22例,其中非癫痫性发作15例（睡眠肌阵挛10例、睡眠障碍3例、阵发性肌张力不全,生长痛各1例）。结论VEEG是鉴别发作性质及类型的最有效检查方法,也是鉴别癫痫与非癫痫性发作的有效方法。     

Typical absence epilepsy presenting prior to age of 3 years: An uncommon form of idiopathic generalized epilepsy

PURPOSE: An attempt to allocate patients with the clinical features and electroencephalography (EEG) abnormalities of typical absence epilepsy presenting before the age of 3 years, similar to childhood and juvenile absence epilepsy (JAE) and delineate the clinical manifestations, EEG abnormalities, therapy and outcome of such an epileptic disorder by conducting a nationwide survey. RESULTS: Overall, eight infants, six males and two females, abided by the inclusion criteria of typical absence epilepsy: They were born after an unremarkable pregnancy and labor presenting at the age of 12-34 months (mean: 19.6 months) with frequent absences time-linked with an EEG demonstrating generalized occasionally irregular epileptiform discharges of 3-4 Hz spike/wave and normal background activity along with an electrographic photosensitive response in one patient. Neurological examination was intact in all infants. All eight infants were initially treated with valproic acid, of whom seven immediately responded and one had increase in frequency and duration of absences completely aborted with treatment of lamotrigine. Three relapsed after termination of therapy of whom two again presented with recurrent absences and another one with generalized tonic-clonic seizures and as such these children had virtually transformed into a later form of idiopathic generalized epilepsy (IGE) during childhood. All eight patients are seizure-free, seven still on therapy; seven children within a follow-up period of 2-7 years and the most recently diagnosed infant for 6 months. Cognitive skills were found normal in all children within the low normal range in three children with short attention and concentration spans. CONCLUSION: The data presented here delineate a very rare form of idiopathic benign generalized epilepsy presenting with typical absences before age of 3 years and a favorable outcome, similar to childhood and JAE, recognized as distinct IGE syndromes by the International League Against Epilepsy (ILAE) classification.     

The classification and differential diagnosis of absence seizures with short-term video-EEG monitoring during childhood

Absence seizures are idiopathic epilepsies characterized by impairment of consciousness and generalized 2.5-4 Hz spike and slow wave discharges. This prospective study was performed to classify and define properties of subgroups of absence epilepsies. We included 31 patients, of whom seven were in the differential diagnosis group. On admission, absence epilepsy provisional diagnosis was considered in 16 patients clinically and in the other 15 patients based on routine EEG findings. Ictal EEGs were recorded by video-EEG monitoring in 23 of the patients (totally 202 ictal recordings). Patients were diagnosed as childhood absence epilepsy (n=8), juvenile absence epilepsy (n=10), juvenile myoclonic epilepsy (n=3), eyelid myoclonia with absences (n=2), and perioral myoclonia with absences (n=1). Neuroimaging, video-EEG monitoring and especially ictal recordings are important for classification of epilepsies in addition to history, physical examination and routine EEG findings. Video-EEG monitoring is required to classify, to make differential diagnosis and to determine the treatment plan and prognosis.