儿童病毒性脑炎脑电图的波幅与预后观察

目的：探讨儿童病毒性脑炎脑电图的波幅与预后的关系。方法：对28例儿童病毒性脑炎患者的脑电图波幅与预后、后遗症的发生率进行分析。结果：病毒性脑炎患者的脑电图记录背景活动表现为低波幅慢者预后差,后遗症发生率高。结论：对脑电图表现为低波幅慢活动异常的病毒性脑炎的患儿应及时积极的抗感染、护脑治疗,以减少后遗症的发生。     

脑电图对小儿病毒性脑炎诊断和转归的评价

目的探讨病毒性脑炎儿童脑电图异常与病情及预后关系。方法对96例病毒性脑炎的脑电图结果进行回顾性分析。结果脑电图异常率为94.8%。轻型、普通型多表现为弥漫性中波幅或高波幅慢波改变,预后好。重症组以局限性、低波幅慢波多见,预后差。脑电图出现癫样放电者,应警惕继发癫的可能。结论脑电图对小儿病毒性脑炎诊断和转归评估中有较高的价值。     

脑电图在小儿病毒性脑炎转归中的监测作用

目的 分析脑电图在小儿病毒性脑炎转归中的监测作用。方法 对234例病毒性脑炎的脑电图进行跟踪观察并予回顾性分析。结果 病毒性脑炎脑电图为高波幅δ波或局限性慢波，其后遗症以继发性癫痫多见，低波幅δ波其后遗症发生率高，以智能、运动障碍多见。结论 脑电图对转归中的脑功能的恢复判断、治疗效果、疾病复发、后遗症产生的监测非常重要。     

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.     

小儿病毒性脑炎脑电图对预后的判断意义

目的分析脑电图在小儿病毒性脑炎康复中的监测作用。方法对60例病毒性脑炎患儿中脑电图异常的54例进行跟踪观察并回顾性分析。结果脑电图首次检查正常6例(10.0%),异常54例(90.0%)。病毒性脑炎患儿脑电图多以弥漫性θ、δ波为主,本组弥漫性异常48例,占88.9%。以低波幅δ波为主的重度异常和局限性阵发性异常者多见后遗症和继发性癫。结论脑电图对病毒性脑炎虽无显著特异性,但有较好的敏感性,特别是对病毒性脑炎后的继发性癫在临床发作前可捕捉到癫波。脑电图对病毒性脑炎康复中脑功能恢复的判断、治疗效果、疾病复发、后遗症的产生等监测同样有重要的意义。     

神经元表面抗体相关脑炎脑电图特点分析

目的总结神经元表面抗体相关脑炎临床表现、脑电图和头部MRI特点,探讨脑电图对判断疾病复发或波动的意义,以及与MRI病灶相对应的脑电图特点和各临床病程分期的脑电图特点。方法共23例神经元表面抗体相关脑炎患者,根据临床病程分期分为上升期、极期、下降期和恢复期,记录脑电图背景活动、慢波分布范围、样放电和极度δ刷,分析其与疾病复发或波动的关系、与头部MRI表现的一致性,以及各病程分期的脑电图特点。结果 23例患者中19例为抗N-甲基-D-天冬氨酸(NMDA)受体脑炎、3例为抗富亮氨酸胶质瘤失活基因1抗体相关脑炎、1例为抗γ-氨基丁酸B型受体脑炎。临床症状发生率由高至低依次为精神症状或认知功能障碍、癫发作、意识障碍、言语障碍和运动障碍。发病30.50 d内6例脑电图背景活动为慢波,其中2例疾病复发或波动;5例背景活动为α节律,无一例复发或波动。有极度δ刷与无极度δ刷的抗NMDA受体脑炎患者首次住院时间(Z=-0.785,P=0.433)和疾病复发或波动发生率(Fisher确切概率法:P=0.155)差异均无统计学意义。各病程分期脑电图背景活动与头部MRI表现并不完全匹配。上升期和极期脑电图背景活动多为慢波,且慢波分布范围相对较广泛;自下降期开始,背景活动以α节律为主;恢复期慢波分布范围缩小。结论疾病早期脑电图背景活动可能与疾病复发或波动有关。各病程分期脑电图改变与头部MRI表现的不匹配提示应重视神经元表面抗体相关脑炎患者的神经功能检查。不同病程分期脑电图特点不同。     

病毒性脑炎脑电图临床分析

目的探讨病毒性脑炎患者脑电图异常与病情、预后的关系。方法对78例病毒性脑炎患者的病情及脑电图进行回顾性分析。结果在78例病毒性脑炎患者中,68例为脑电图异常,异常率为87%,其中轻度异常脑电图36例(46.1%),中度异常22例(28.2%),重度异常10例(12.8%)。结论脑电图作为临床辅助检查手段,对病毒性脑炎的临床诊断和预后有重要参考价值。     

以共济失调为主要表现的病毒性脑炎36例临床分析

目的提高对以共济失调为主要表现的病毒性脑炎的认识。方法对我科收治的36例患儿采用回顾性总结方法,分析临床表现、诊断与治疗。结果以共济失调为主要表现的病毒性脑炎占同期儿科病脑住院人数0.3%~1%,以急性小脑性共济失调为主要表现,脑电图均有不同程度的慢波增多,采取综合治疗方法,全身症状恢复快,共济失调恢复慢。结论以共济失调为主要表现的病毒性脑炎的诊断采取症状性诊断方法,激素治疗效果好,多数患儿在病程2周~3周恢复,预后良好。     

以共济失调为主要表现的病毒性脑炎36例临床分析

目的 提高对以共济失调为主要表现的病毒性脑炎的认识.方法 对我科收治的36例患儿采用回顾性总结方法,分析临床表现,体征,诊断与治疗.结果 以共济失调为主要表现的病毒性脑炎占同期儿科病脑住院人数0.3%～1%,以急性小脑性共济失调为主要表现,脑电图均有不同程度的慢波增多,采取综合治疗方法,全身症状恢复快,共济失调恢复慢.结论 以共济失调为主要表现的病毒性脑炎的诊断采取症状性诊断方法,激素治疗效果好,多数患儿在病程2周～3周恢复,预后良好.     

儿童重型病毒性脑炎预后的相关因素分析

目的回顾性分析儿童重型病毒性脑炎患者的临床资料,探讨影响其预后的相关因素。方法收集我院2011-03—2014-06儿科病房收治的112例重症病毒性脑炎患儿的临床资料,并在患儿出院后6个月时采用Liverpool预后评分量表评估其预后。根据预后情况将患儿分为痊愈组(n=46)和未愈组(n=62),分析患儿各项临床资料与预后的相关性。结果单因素分析发现,惊厥、偏瘫、合并多脏器损伤、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处对SVE预后均有影响(P0.05),为影响SVE预后的因素。患儿性别、年龄、有无发热、意识障碍、低钾血症、脑电图轻度异常、单侧幕上单一病灶对预后均无影响。多因素Logistic回归分析显示,惊厥、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处为SVE预后不良的高危因素。合并其他脏器损伤及偏瘫不是预后不良的高危因素。结论儿童SVE患者预后差,严重后遗症发生率及病死率高,严重威胁儿童的生存及生活质量,惊厥、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处等因素是儿童重症病毒性脑炎预后不良的高危因素。     

62例病毒性脑炎脑电图与临床及CT分析

为探讨病毒性脑炎（病脑）患者脑电图（EEG）与临床及CT之间的关系,将临床确诊的62例病脑患者进行EEG与CT检查,对其EEG异常的阳性率、异常程度与病程、临床表现、CT之间的关系进行比较分析,并作统计学处理。结果发现,发病10天以内EEG中、重度异常39倒（78%）,与10天以后比较有显著性差异（P＜0．001）。EET可表现为三种形式：以弥漫性异常为主（51.5％）;弥漫性异常伴局灶慢波（32．3%）;局灶性异常（16．2%）。EEG与CT之间无明显相关性（P＞0．05）。提示：EEG检查对病脑的诊断、鉴别诊断,以及动态观察病情、判断预后有重大意义。CT不能取代EEG。     

EEG in neonatal herpes simplex encephalitis

The EEGs of 21 newborns with herpes simplex encephalitis were analysed. The diagnosis was based on the demonstration of herpes simplex infection in association with neurological symptoms, other etiological factors being excluded. Sixteen of 21 babies (76%) showed in their EEGs electrical seizures, either focal or unilateral. These paroxysms consisted of sharp waves or slow waves repeating at pseudo-periodic intervals, usually of 0.5-2 sec. Individual paroxysms had a duration of 10-20 sec in 6 babies and 1-2 min in 10 patients. During the same period, 20 other babies displayed the same EEG finding. Of these, 11 had encephalitis of unknown etiology. In our series there appeared to exist a correlation between both the duration of the electrical seizures and the degree of EEG background abnormality and the clinical outcome. Babies with markedly abnormal background and long-lasting paroxysms tended to have a poor prognosis. It is concluded that in newborns with clinical signs of encephalitis who show in their EEGs paroxysms of the type described, the possibility of herpes simplex encephalitis should be considered.     

伴强直性发作癫痫患儿的临床表现和脑电图特征

目的通过对67例伴强直性发作癫痫患儿的临床表现及视频脑电图(VEEG)特点分析,提高对该发作类型的诊断水平。结果收集河北省儿童医院神经内科67例伴强直性发作的癫痫患儿的病例资料,分析其临床表现和VEEG特征。结果 67例患儿均监测到明确的临床发作,其中清醒期发作19例(28%),睡眠期发作30例(45%),且容易出现在睡眠I期、II期。发作间期脑电图表现:①背景活动正常37例,慢化者15例;②广泛性棘波节律阵发,易出现在非快速眼动期(NREM期);③广泛性及多灶性慢波、棘慢波或多棘慢波阵发;④一侧或双侧前头部棘波、棘慢波或θ活动发放;⑤单侧或双侧Rolandic区棘慢波发放;⑥高度失律。发作期脑电图表现:①局灶起始的棘波节律发放;②广泛性棘波节律发放;③广泛性慢波阵发,其上复合或其后跟随棘波节律;④广泛性4~6Hz棘慢波发放→广泛性棘波节律阵发;⑤广泛性低波幅棘波节律发放→广泛性高波幅棘慢波阵发。以上表现形式有时会组合出现于同一例患者中。发作持续时间与背景活动的关系:发作持续约1~8s者39例(39/67,58.2%),背景活动慢化者4例(4/39,10.3%);发作持续8~15s,甚者更长者(15s)28例(28/67,41.7%),背景活动慢化者11例(11/28,39.3%)。67例患者随访研究1年,最终诊断为:8例(11.9%)诊断为婴儿痉挛征,7例(10.4%)诊断为Lennox-Gastaut综合征(LGS),3例(4.4%)诊断为额叶癫痫,15例(22.3%)诊断为伴有中央颞区棘波的儿童良性癫痫(BECT),34例(50.7%)仅停留在发作类型的诊断层面。结论强直性发作可单独出现,也可出现在多种癫痫综合征中;VEEG可监测患儿发作期临床表现及脑电图异常波形,为临床诊断及鉴别诊断提供理论依据。     

Clinical characteristics and prognostic factors of postencephalitic epilepsy in children

The goal of this study was to clarify the clinical characteristics and prognostic factors of childhood postencephalitic epilepsy. Forty-four patients (20 boys and 24 girls; age range 21 months to 17 years, mean age 8.1 +/- 4.6 years) with postencephalitic epilepsy were selected from the 798 epileptic children treated and followed up at our hospital between 1993 and 2003. The clinical data included clinical features, electroencephalograms (EEGs), and neuroimages, all reviewed and analyzed retrospectively. Based on their post-treatment seizure outcomes, the children were divided into favorable (n = 20) and poor outcome groups (n = 24). Between the two groups, the age at encephalitis, cerebrospinal fluid findings, and seizure type were comparable. Factors indicating a poor prognosis for these patients during the acute phase of encephalitis were (1) status epilepticus occurring as the first seizure (P < .005), (2) slow background activity (P < .001) and multifocal spike discharges on EEGs (P < .01), and (3) herpes simplex viral encephalitis (P < .01). Our findings indicated that patients with status epilepticus and multifocal spikes on EEG during acute encephalitis have an increased risk of developing intractable epilepsy. To improve the outcome of postencephalitic epilepsy, intervention must occur earlier in the encephalitis stage.     

Constantly discontinuous EEG patterns in full-term neonates with hypoxic-ischaemic encephalopathy.

OBJECTIVES: Selected EEG features were evaluated in 21 constantly discontinuous tracings recorded on the same number of full-term neonates with hypoxic-ischaemic encephalopathy. METHODS: The tracings were examined without using interval amplitude as the basis for distinguishing between burst-suppression and nonburst-suppression patterns. RESULTS: The results were related to outcomes and other clinical parameters (severity of hypoxic-ischaemic encephalopathy, pO2 levels and drug intake). CONCLUSIONS: Features defining the grade of EEG discontinuity (i.e. maximum interval duration, minimum burst duration and interval amplitude) significantly related to outcome and, in most cases, to the grade of hypoxic-ischaemic encephalopathy. Other features (amplitude of slow waves within the burst and incidence of abnormal EEG transients) related to PO2 levels. The consumption of anticonvulsant drugs increased EEG discontinuity, but this effect did not seem dose-related. Finally, the persistence of a constantly discontinuous EEG pattern after the first week of life is a sign of unfavourable prognosis. In full-term neonates with hypoxic-ischaemic encephalopathy quantitative analysis of all constantly discontinuous EEGs seems more useful than only describing burst-suppression patterns on the basis of interval amplitude.     

Neurologic, neuropsychologic, and electroencephalographic findings after European tick-borne encephalitis in children

Tick-borne European early summer meningoencephalitis is believed to be a benign disease in childhood. The causative RNA virus is from the same family as the West Nile virus, and the respective clinical presentations have many similarities. We studied 19 German children who had suffered from tick-borne encephalitis virus meningitis or meningoencephalitis in an endemic area and compared them with 19 matched controls. Epidemiologic data were consistent with known features of tick-borne encephalitis infection in southern Germany. None of the children studied had severe neurologic or neuropsychologic sequelae. One child developed significant clinical depression shortly after the illness. Electroencephalograms (EEGs) from children with tick-borne encephalitis were significantly slower on follow-up than control EEGs. After tick-borne encephalitis, children had a higher likelihood of having an impairment of attention and psychomotor speed. Using the Touwen neurologic examination, after tick-borne encephalitis, children had lower scores than control children on 4 of the 10 subsystems. Owing to the small sample size, it was difficult to identify risk factors for and predictors of adverse outcomes.     

Neonatal herpes simplex meningoencephalitis: EEG investigations and clinical correlates

We studied the sequential EEGs of 15 neonatal herpes simplex virus meningoencephalitis (NHSV-ME) patients and correlated them with corresponding clinical and laboratory findings. During days 1 to 4 of the illness, 8 had EEGs. All but 1 had abnormal tracings and 3 (38%) showed the multifocal periodic pattern (MPP). Three had an early abnormal EEG at a time when their cranial CT/ultrasound studies were normal. During days 5 to 11, 13 had EEGs: all were abnormal and 3 showed the MPP. After day 11, EEGs (available on 10) showed a very low voltage background in 9, and only 1 had normal EEG and development. During 1 year in which 1 patient with NHSV-ME was observed, we noted that 9/324 (2.8%) of neonates with other CNS conditions manifested the MPP. All, however, had CSF findings that distinguished them from herpes cases. We conclude that: (1) In patients with suspected NHSV-ME, EEG is a sensitive test that is superior to radiologic procedures in detecting early cerebral involvement. Most of the early EEGs show nonspecific background and paroxysmal abnormalities. (2) In the presence of inflammatory CSF, the MPP, an otherwise nonspecific finding, is highly suggestive of NHSV-ME. (3) Sequential EEGs may be important in the follow-up of neonates with NHSV-ME.     

The prognostic value of the electroencephalogram in premature infants

A retrospective analysis of 184 EEGs performed during the neonatal period was accomplished on 81 premature infants (gestational age less than or equal to 36 weeks). The neurological outcome of the 64 surviving infants, considered as normal or abnormal with minor or major sequelae, was compared with the neonatal EEGs which were graded as normal, moderately or markedly abnormal. Infants whose serial EEGs were normal during the neonatal period were usually normal at follow up or suffered minor sequelae. All the children who had at least one markedly abnormal EEG suffered some type of neurological sequela or died. EEGs were classified as markedly abnormal if they contained at least one of the following patterns: isoelectric or paroxysmal backgrounds, positive rolandic sharp waves, electrographic seizures, marked interhemispheric voltage asymmetry or asynchrony or excessively slow background with a reduction or absence of the patterns expected at the particular conceptional age. A moderately abnormal EEG was of no significant prognostic value. This study also revealed the value of recording serial EEGs in the neonatal period. In many cases, markedly abnormal EEG patterns were transient and normal records were often obtained prior to the child's release from the nursery.     

Abnormal brushes in preterm infants with periventricular leukomalacia

OBJECTIVE: The aim of this study is to describe a new objective method of detecting white matter injury by use of refiltering function of digital EEG. STUDY DESIGN: The neonatal EEGs of 9 patients with PVL were analyzed retrospectively, and compared with EEGs of 18 normal infants without PVL. Abnormal brushes were counted on the refiltered EEG where low cut filter were set at 10 Hz so that slow waves were eliminated. Abnormal brushes were defined as spindle-like fast wave bursts with maximal amplitudes higher than 40 mV and frequencies between 13 Hz and 20 Hz, which were easily distinguishable from a flat background. RESULTS: The incidence of abnormal brushes in infants with PVL was 0.25/min, 0.45/min, 2.08/min, and 0.62/min on the frontal, central, occipital, and temporal region, respectively. The incidence in infants without PVL was 0.14/min, 0.08/min, 0.24/min, and 0.19/min, respectively. Abnormal brushes were observed more often in infants with PVL on the central, occipital, and temporal region than in infants without PVL. Localization of abnormal brushes was also correlated with the lesion of white matter injury on MR images and clinical outcome. CONCLUSION: Our results indicated that abnormal brushes on refiltered EEGs were strongly associated with white matter injury.