早发性儿童良性枕叶癫痫54例脑电图表现

目的:探讨早发性儿童良性枕叶癫痫脑电图表现。方法:选取早发性儿童良性枕叶癫痫患儿,回顾性分析其病例资料、脑电图资料、随访结果。结果:共收集患儿51例,发病年龄为2.2~8.5岁。有热性惊厥或癫痫家族史15例,有热性惊厥史12例,伴Rolandic发作6例。脑电图示39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。应用卡马西平、丙戊酸钠和妥泰等治疗本病;发作基本消失33例,明显减轻12例,病情波动6例。脑电图表现痫性放电减轻24例,变化不明显12例,正常15例。轻度学习困难和行为异常21例,其他患儿的神经精神发育未见异常。结论:早发性良性儿童枕叶癫痫是一种良性、特发性、与年龄和部位相关的癫痫综合征,脑电图示枕区或枕外区局灶或多灶性放电及游走性演变。     

以癫痫为首发的糖尿病误诊2例

1病例报告 例1：男，56岁。因阵发性左面部抽动伴同侧肢体抽动5个月，曾在某医院门诊对症处理无效。查体：BP126／74mmHg，左面部及左侧肢体肌力弱．深浅反射减弱。血、尿、粪常规检查和心电图无异常发现，脑电图示右侧半球呈局限性棘-慢波，以局限性癫痫入院治疗，入院后观察抽搐症状每日发作8～15次，每次持续15-20s，发作时神志清楚，抗癫痫治疗4周无效。     

额叶非惊厥性癫痫持续状态临床和脑电图特征

  目的  探讨额叶非惊厥性癫痫持续状态的临床和脑电图特点。  方法  对北京协和医院神经科2009年8月至2010年8月收治的3例额叶非惊厥性癫痫持续状态患者的临床和视频脑电资料进行分析。  结果  3例患者均为女性, 发作时的临床表现既有相似之处(均表现有意识损害, 认知功能障碍, 不伴有惊厥发作)又有各自特点。同步脑电图示发作起源于额部但波型各不相同, 分别为棘慢复合波节律、慢波节律和尖波节律。虽然即刻结局良好:2例患者发作被静脉注射地西泮中止, 另1例持续40 h后自然停止。但随访证实3例患者均反复发作, 作为部分性发作一线抗癫痫药物的卡马西平疗效不佳。  结论  额叶非惊厥性癫痫持续状态是一组临床和脑电图表现复杂多样具有特征性的综合征, 及时行发作期脑电图检查是诊断的关键。卡马西平治疗可能反应欠佳。     

36例脑瘫合并癫痫的临床发作类型与脑电图分析

目的了解脑瘫合并癫痫的临床发作类型与脑电图的关系。方法对36例癫痫发作间歇期的脑瘫患儿采用视频脑电图仪，按国际10-20系统放置头皮电极检测脑电图。结果脑瘫合并癫痫患儿发作间歇期脑电图表现为限局性高波幅的棘慢波发放占55．6％（20／36）；典型高度失律4例；高度失律改善型3例；双侧导联棘慢波发放的占25％（9／36）。结论脑瘫患儿癫痫发作类型及脑电图改变多符合部分性发作的特点。     

抗GQ1b抗体综合征复发伴癫痫罕见病例1例报道并文献回顾

目的：探讨抗GQ1b抗体综合征患者出现癫痫罕见临床表现的发病机制及临床特点。方法：报道1例癫痫发作的抗GQ1b抗体综合征患者的临床资料,并进行文献复习。结果：患者为青少年女性,因“行走不稳5月余,突发肢体抽搐1天”就诊。查体示对称性眼外肌麻痹、腱反射活跃及共济失调;血清抗GQ1b抗体IgG（+）,脑电图示双侧大脑半球散发3～4 Hz棘慢波、多棘慢波,磁共振示双侧额叶、左侧顶叶、双侧丘脑及脑干异常信号。诊断为抗GQ1b抗体综合征Bickerstaff’s脑干脑炎型,给予抗癫痫、类固醇激素及免疫抑制剂等治疗后好转。检索文献收集相关病例报道4篇,基础实验提示GQ1b抗原与癫痫的发病机制密切相关。结论：癫痫为抗GQ1b抗体综合征罕见临床表现,推测与GQ1b抗原分布特点、抗体浓度及血脑屏障渗透性有关,其潜在机制仍需进一步研究。     

偏头痛与癫痫的视频脑电图分析研究

2010年7月～2012年5月因头痛发作在我院诊断为偏头痛46例,癫痫4例,比较分析两者的脑电图特点。偏头痛组31例正常,15例异常,其中非特异性异常14例,脑电图为发作间期或发作期阵发性θ、δ活动增多,1例见枕区慢波夹杂少量散发棘波;癫痫组其中3例为反复双侧后头部或枕区棘慢波发放,1例为右侧前颞区棘波、尖波发放并波及额区。VEEG对于偏头痛及癫痫的鉴别诊断有重要辅助作用,但鉴别不能完全依赖脑电图,需关注两者有共病可能。     

婴儿良性癫痫的临床特征以及对智力发育的影响:3年随访

目的观察婴儿良性癫痫的发作特征、治疗反应及本病对智力发育的影响。方法1998-03/2002-12,对2岁内起病,排除高热惊厥、婴儿痉挛症及发育异常的婴儿惊厥进行临床观察、脑电图监测、用药效果,在3岁后进行了智力测定。结果经临床观察12例患儿确诊为婴儿良性癫痫。其中表现为全身性惊厥者5例,发作时间多为入睡前或凌晨;口—咽自动症3例;阵发性青紫4例,均发生在白天。全部病例均为短期内频繁发作,无癫痫持续状态。其中8例脑电图正常;2例发作期出现一侧和双侧枕叶局限而持续的棘慢波;2例出现一侧性颞区小尖棘波,发作间期背景活动正常。11例接收抗癫痫单药治疗,平均用药时间1年,1例未用任何药物治疗,全部患儿起病1年内发作均消失。并在3～6岁内接受了智力测定。与正常儿童对照差异无显著性意义(t=9.032,P>0.05)。结论婴儿良性癫痫临床特征明显,患儿的智力发育不受影响。     

小儿惊厥46例临床与视频脑电图分析

目的：了解不同原因惊厥后痫波发生率，及时发现癜痫和癜痫综合症。方法：对46例惊厥患儿进行临床观察。结果：本组46例患儿出现波19例占39．1％，其中热性惊厥组（26例）痫波10例占38．5％，低钙低镁组（6例）痫波1例占16．7％，癫痫组（6例）痫波6例，性脑炎组（2例）痫波2例。结论：对惊厥患儿应及时进行视频脑电图监测以尽早发现癫痫和癫痫综合症采取合理的干预措施。热性惊厥组video—EEC痫波特征与患儿年龄有无惊厥史发热程度及本次惊厥持续无关。     

儿童植物神经性癫痫诊断与脑电图的关系

目的：探讨儿童植物神经性癫痫的诊断与脑电图的关系。方法：采用日本光电公司EEG－4414脑电图机，按10／20系统，对我院诊断为植物神经性癫痫患儿110例在安静、非空腹状态下进行单极、双极多联脑电图描记检查。结果：110例患儿脑电图记录中，5例正常，12例有棘波，35例有阵发性高波幅慢波节律发放，13例有阵发性低波幅快波发放，25例有棘波、尖波、棘慢综合波发放，15例有阵发性14－6Hz阳性棘波，56例有局限性慢波活动，1例为高峰节律失常，9例过度换气诱发阵发性高波幅慢活动，7例过度换气诱发棘慢波发放。采用一种抗癫痫药物治疗，病情均得到控制。复查脑电图，均有不同程度的改善和恢复。结论：脑电图检查不仅对诊断有着特殊价值，而且对治疗及预后追踪亦有一定的指导意义。     

小儿惊厥46例临床与视频脑电图分析

目的：了解不同原因惊厥病发生率，及时发现癫痫综合症。方法：对46例惊厥患儿进行临床观察。结果：本组46例患儿出现波19例占39．1％，其中热性惊厥组（26组）癫痫波10例占38．5％。低钙低镁组（6例）痫波1例占16．7％，癫痫组（6例）痫波6例，性脑炎组（2例）痫波2例。结论：对惊厥患儿应及时进行视频脑电图监测以尽早发现癫痫和癫痫综合症采取合理的干预措施。热性惊厥组video—EEG痫波特征与患儿年龄有无惊厥史发热程度及本次惊厥持续无关。     

癫痫患者对痫性发作的自我知晓研究

目的:研究痫性发作后患者对癫痫事件发生的自我知晓程度。方法:癫痫患者39例痫性发作后1 h,在视频脑电监测下询问患者是否出现痫性发作,并通过视频脑电图确认痫性发作的种类、发作时间等,进行统计学分析。结果:接受视频脑电监测的39例癫痫患者共有69次痫性发作,痫性发作不知晓37次(53.6%)。痫性发作不知晓率在复杂部分性发作为89.3%,全身强直-阵挛发作为58.8%,单纯部分性发作为8.3%,三者差异有统计学意义(P<0.05);脑电图初始改变出现在左侧大脑半球的痫性发作不知晓率为75.8%,右侧大脑半球为33.3%,差异有统计学意义(P<0.05)。结论:癫痫患者的痫性发作不知晓率>50%。痫性发作所致的意识受损程度及痫性发作的起源部位可能是影响患者对痫性发作自我知晓的原因。     

静息态fMRI观察恒河猴慢性酒精暴露模型诱导期后脑功能改变

目的 采用3.0T静息态fMRI基于分数低频振荡幅度（fALFF）算法分析恒河猴慢性酒精暴露模型诱导期后脑功能活动改变。方法 建立7只雄性健康恒河猴慢性酒精暴露模型,分别于建模前及诱导期后行静息态fMRI,采用fALFF算法获得与建模前比较fALFF值差异有统计学意义的脑区。结果 与建模前比较,恒河猴慢性酒精暴露诱导期后fALFF值减低的脑区包括左侧额中回、左侧小脑半球和左侧枕下回（P均<0.05）,fALFF值增高的脑区包括右侧中央前回、右侧额中回、右侧楔叶、右侧枕中回和右侧小脑蚓部（P均<0.05）。结论 恒河猴慢性酒精暴露模型诱导期后静息态脑功能活动即出现明显改变,表现为左半脑减低,右半脑增强。     

Ipsilateral Deficits in 1-Handed Shoe Tying After Left or Right Hemisphere Stroke

Poole JL, Sadek J, Haaland KY. Ipsilateral deficits in 1-handed shoe tying after left or right hemisphere stroke.

Objective

To examine 1-handed shoe tying performance and whether cognitive deficits more associated with left or right hemisphere damage differentially affect it after unilateral stroke.

Design

Observational cohort comparing ipsilesional shoe tying, spatial and language skills, and limb praxis.

Setting

Primary care Veterans Affairs and private medical center.

Interventions

Not applicable.

Participants

Volunteer right-handed sample of adults with left or right hemisphere damage and healthy demographically matched adults.

Main Outcome Measure

The number of correct trials and the total time to complete 10 trials tying a shoe using the 1-handed method.

Results

Both stroke groups had fewer correct trials and were significantly slower tying the shoe than the control group. Spatial skills predicted accuracy and speed after right hemisphere damage. After left hemisphere damage, accuracy was predicted by spatial skills and limb praxis, while speed was predicted by limb praxis only.

Conclusions

Ipsilesional shoe tying is similarly impaired after left or right hemisphere damage, but for different reasons. Spatial deficits had a greater influence after right hemisphere damage, and limb apraxia had a greater influence after left hemisphere damage. Language deficits did not affect performance, indicating that aphasia does not preclude using this therapy approach. These results suggest that rehabilitation professionals should consider assessment of limb apraxia and ipsilesional skill training in the performance of everyday tasks.     

脑电监测在癫痫患者间期皮层和皮层下高代谢灶的判读中的应用

目的　探讨癫痫患者无临床发作情况下18F氟脱氧葡萄糖(18Ffluorodeoxyglucose,18FFDG)正电子发射计算机断层 (positron emission tomography, PET)脑显像呈现高代谢时脑电监测的应用价值。 方法　对北京协和医院2008年1月至2014年3月共3例无临床发作的间期情况下18FFDG PET脑显像呈现皮层或皮层下高代谢的癫痫患者, 静脉注射安定抑制皮层放电，在脑电监测确认无皮层异常放电时复查18FFDG PET脑显像，并对比两次显像结果。结果　病例1为颞叶癫痫患者，在无临床发作时18FFDG PET显像除发现右颞低代谢外，右额部分皮层及同侧基底节、丘脑及左侧小脑局灶代谢增高。脑电监测下抑制皮层放电后的18FFDG PET显像示原额叶皮层及同侧基底节、丘脑、对侧小脑高代谢灶消失。表明该患者上述高代谢灶为颞叶外皮层潜在致痫灶亚临床放电所致，同时证实了致痫灶与同侧基底节丘脑、对侧小脑之间的神经传导。此例改变了先前单纯前颞叶切除术的临床决策。病例2的间期18FFDG PET显像发现右侧大片额叶皮层高代谢，脑电监测下抑制临床下放电后，原皮层高代谢仍存在，原同侧基底节、对侧小脑的高代谢已不明显,证实皮层存在高代谢的基础病变(炎症)，而基底节丘脑为继发功能改变，确定了病变性质及范围。病例3为颞叶癫痫患者，临床及脑电无法确定癫痫起源部位，磁共振成像未见明显异常。18FFDG PET显像在无临床发作的情况下左侧海马区呈高代谢，脑电监测下在明确的间期状态复查18FFDG PET脑显像，左侧海马区仍为高代谢。提示该部位存在基础病变(肿瘤),帮助临床确定手术部位。 结论　癫痫患者无临床发作情况下18FFDG PET显像呈现高代谢图像时，在脑电监测下确认绝对的间期状态时复查18FFDG PET显像，有助于分析高代谢的病因及明确病变范围，帮助作出临床决策。     

脑电监测在癫痫患者间期皮层和皮层下高代谢灶判读中的应用

  目的  探讨癫痫患者无临床发作情况下¹⁸F-氟脱氧葡萄糖(¹⁸F-fluorodeoxyglucose, ¹⁸F-FDG)正电子发射计算机断层(positron emission tomography, PET)脑显像呈现高代谢时脑电监测的应用价值。  方法  对北京协和医院2008年1月至2014年3月共3例无临床发作的间期情况下¹⁸F-FDG PET脑显像呈现皮层或皮层下高代谢的癫痫患者, 静脉注射安定抑制皮层放电, 在脑电监测确认无皮层异常放电时复查¹⁸F-FDG PET脑显像, 并对比两次显像结果。  结果  病例1为颞叶癫痫患者, 在无临床发作时¹⁸F-FDG PET显像除发现右颞低代谢外, 右额部分皮层及同侧基底节、丘脑及左侧小脑局灶代谢增高。脑电监测下抑制皮层放电后的¹⁸F-FDG PET显像示原额叶皮层及同侧基底节、丘脑、对侧小脑高代谢灶消失。表明该患者上述高代谢灶为颞叶外皮层潜在致痫灶亚临床放电所致, 同时证实了致痫灶与同侧基底节丘脑、对侧小脑之间的神经传导。此例改变了先前单纯前颞叶切除术的临床决策。病例2的间期¹⁸F-FDG PET显像发现右侧大片额叶皮层高代谢, 脑电监测下抑制临床下放电后, 原皮层高代谢仍存在, 原同侧基底节、对侧小脑的高代谢已不明显, 证实皮层存在高代谢的基础病变(炎症), 而基底节丘脑为继发功能改变, 确定了病变性质及范围。病例3为颞叶癫痫患者, 临床及脑电无法确定癫痫起源部位, 磁共振成像未见明显异常。¹⁸F-FDG PET显像在无临床发作的情况下左侧海马区呈高代谢, 脑电监测下在明确的间期状态复查¹⁸F-FDG PET脑显像, 左侧海马区仍为高代谢。提示该部位存在基础病变(肿瘤), 帮助临床确定手术部位。  结论  癫痫患者无临床发作情况下¹⁸F-FDG PET显像呈现高代谢图像时, 在脑电监测下确认绝对的间期状态时复查¹⁸F-FDG PET显像, 有助于分析高代谢的病因及明确病变范围, 帮助作出临床决策。     

Functional implications of ipsilesional motor deficits after unilateral stroke

OBJECTIVE: To investigate the functional impact of ipsilesional motor deficits after unilateral stroke and the best predictors of those deficits. DESIGN: Observational cohort. SETTING: Primary care Veterans Affairs and private medical center. PARTICIPANTS: Volunteer right-handed sample; stroke patients with left (LHD) or right hemisphere damage (RHD) a mean of 3.9 to 5.2 years poststroke and able-bodied participants who were tested using their left (LAB) or right hand. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Jebsen-Taylor Hand Function Test (JHFT). RESULTS: Ipsilesional JHFT performance was impaired to the same extent in the LHD and RHD groups. LHD patients with apraxia had poorer scores on the JHFT than LHD patients without apraxia and the LAB group. Regression analyses showed that severity of apraxia was the best predictor of JHFT performance for the LHD group and that right (ipsilesional) motor performance (grip strength, finger tapping) was the best predictor of JHFT performance for the RHD group. CONCLUSIONS: Ipsilesional deficits are present on simulated activities of daily living after LHD or RHD, suggesting that rehabilitation after stroke should include the ipsilesional arm and that ipsilesional limb apraxia is a better predictor of ipsilesional functional motor skills after LHD than aphasia or simple motor skills (grip strength, finger tapping). These findings suggest that limb apraxia should be assessed more routinely after stroke of the left hemisphere.     

Meralgia paresthetica secondary to limb length discrepancy: case report

Meralgia paresthetica consists of pain and dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (L2-L3) underneath the inguinal ligament. Abdominal distension, tight clothing, and hip hyperextension are all described causes of this condition. To our knowledge this has never been attributed to a limb length discrepancy. We present a 51-year-old man with a long-standing history of right sided meralgia paresthetica. History and physical and radiological examination were unrewarding except that his left leg was shorter than the right by 2 cm. Nerve conduction studies of the lateral femoral cutaneous nerve on the left had a normal latency and amplitude but were absent on the right. To prove the hpothesis that the limb length discrepancy was responsible for the condition, a single subject study was performed. The presence or absence of pain and dysesthesia in the right thigh was the observed behavior. Intervention consisted of wearing a 1.5-cm lift in the left or right shoe for 2 weeks each with an intervening 2-week lift-free period. Pain was recorded on a numeric scale and numbness as being present or absent. There was continuing pain without and with the lift in the right shoe but no pain or numbness with the lift in left shoe. It was concluded that the limb length discrepancy was responsible for the meralgia paresthetica. Pertinent literature and possible pathomechanics are discussed.     

Hemispheric differences in hemodynamics elicited by auditory oddball stimuli

Evidence from neuroimaging studies suggests that the right hemisphere of the human brain might be more specialized for attention than the left hemisphere. However, differences between right and left hemisphere in the magnitude of hemodynamic activity (i.e., 'functional asymmetry') rarely have been explicitly examined in previous neuroimaging studies of attention. This study used a new voxel-based comparison method to examine hemispheric differences in the amplitude of the hemodynamic response in response to infrequent target, infrequent novel, and frequent standard stimuli during an event-related fMRI auditory oddball task in 100 healthy adult participants. Processing of low probability task-relevant target stimuli, or 'oddballs', and low probability task-irrelevant novel stimuli is believed to engage in orienting and attentional processes. It was hypothesized that greater right-hemisphere activation compared to left would be observed to infrequent target and novel stimuli. Consistent with predictions, greater right hemisphere than left frontal, temporal, and parietal lobe activity was observed for target detection and novelty processing. Moreover, asymmetry effects did not differ with respect to age or gender of the participants. The results (1) support the proposal that the right hemisphere is differentially engaged in processing salient stimuli and (2) demonstrate the successful use of a new voxel-based laterality analysis technique for fMRI data.     

Quality of life in patients with right- or left-sided brain tumours: literature review

Aims. To determine if patients with left‐ or right‐sided hemisphere neoplasm perceive their quality of life (QoL) differently. Background. It is not clear whether patients with a lesion in the left hemisphere have a different QoL than those with a lesion in the right hemisphere. (1) In the pre‐operative period, patients with a left‐sided lesion may have different symptoms according to the position of the tumour. (2) Studies on patients with brain injury demonstrate an association between left frontal lesions and depression: depression can alter the patients’ perception of QoL. (3) In the postoperative period, right‐handed patients may be disadvantaged by surgical trauma to the motor cortex in the left hemisphere. (4) During the different phases of the disease, the various functions of the two hemispheres may influence the patient's capacity to control QoL; also, as suggested by authors, both the ego and the conscience are mostly located in the left hemisphere. This is the reason that patients with a left‐sided lesion may perceive a worse QoL. Methods. A review of literature was carried out using the Medline database (1966–2007) and CINHAL (1982–2007), using the following Mesh Terms and key words: brain neoplasm, tumour or cancer, hemispheric dominance or laterality or right or left hemisphere, QoL. Results. Seven studies emerged that documented non‐homogeneous results and which included different populations. The association between QoL and the side of the lesion was evaluated. Conclusions. The lack of a substantial number of recent, robust follow‐up studies investigating the QoL in patients at different stages of disease and treatment indicates that more research is needed. Relevance to clinical practice. Understanding the QoL in patients with brain neoplasm and the differences between right and left hemisphere sites of the neoplasm can help nurses develop different interventions and offer more guidance for effective clinical intervention.     

健康受试者脑磁图M100发生源大脑半球空间位置差异的研究

目的研究健康受试者脑磁图脑诱发磁场发生源大脑半球空间位置差异。方法对31例健康受试者(男27例,女4例)分别给予左、右耳纯音刺激,刺激强度为90dB,频率为2kHz,刺激间隔1s,持续时间8ms,记录脑听觉诱发磁反应(AEFs)。结果AEFs的主要波峰为M100,位于双侧大脑半球颞横回,两侧ECD位置由头坐标系统中的X、Y、Z轴表示,结果显示给予左耳纯音刺激,ECD在左、右侧大脑半球X、Z轴无显著性差异(P>0.05),ECD在左、右侧大脑半球Y轴有显著性差异(P<0.05),给予右耳纯音刺激,ECD在左、右侧大脑半球X、Z轴无显著性差异(P>0.05),ECD在左、右侧大脑半球Y轴有显著性差异(P<0.05)。结论健康青年人对纯音刺激的诱发磁反应左、右侧半球反应位置在Y轴存在显著性差异,M100位置均在Y轴显示不对称,即左侧M100位置位于颞横回偏后,右侧M100位置位于颞横回偏前。