成人原发性癫(癎)患者63例睡眠结构分析

目的:了解癫(癎)患者睡眠结构及夜间激醒、腿动、呼吸事件特点.方法:对63例成人原发性癫(癎)患者(病例组)及40名正常人(对照组)的夜间多项睡眠图(PSG)结果进行分析.结果:两组入睡潜伏期、REM潜伏期、睡眠维持率、睡眠效率、浅睡期比例、深睡期比例、REM期比例和清醒期比例、分别为(87.64±27.94)min VS(150.33±82.26)min(P＜0.05)、(13.11±5.23)min VS(17.34±19.26)min(P＞0.05)、(0.58±0.09)VS(0.70±0.50)(P＜0.05)、(0.22±0.07)VS(0.16±0.35)(P＜0.05)、(0.20±0.05)VS(0.14±0.38)(P＜0.05)、(0.08±0.07)VS(0.17±0.90)(P＜0.05)、(0.91±0.07)VS(0.89±0.07)(P＜0.05)和(0.96±0.03)VS(0.81±0.16)(P＜0.05).两组夜间激醒指数、在NREM期激醒指数、孤立性腿动指数、在REM期及NREM期孤立性腿动指数、呼吸暂停指数、低通气指数、呼吸暂停低通气指数比较P值均＜0.05,差异有统计学意义.结论:成人原发性癫(癎)患者存在夜间睡眠结构紊乱、睡眠质量较差和睡眠呼吸障碍.     

儿童非癫(癎)的癫(癎)样发作34例临床分析

目的 探讨儿童非癫(癎)样的癫(癎)样发作的临床特点及诊断.方法 对我院34例临床拟诊癫(癎)的发作性疾病做视频脑电图检查并进行分析.结果 34例临床拟诊癫(癎)病患儿视频脑电图检查结果 示患儿临床发作时同步脑电图无癫(癎)波发放.结论 诊断儿童癫(癎)病应慎重,视频脑电图是确诊癫(癎)与非癫(癎)可靠有效的方法.     

临床下(癎)样放电对数学认知功能的影响

目的探讨临床下样放电对数学认知功能的影响。方法对11例经丙戊酸钠治疗后临床发作控制、但仍有频繁的临床下伴中央-颞区棘波的良性癫(BECTS)患儿(BECTS组)和11名正常儿童(正常对照组)进行以数学运算为刺激的事件相关电位(ERP)检测,并对检测结果进行比较分析。结果与正常对照组比较,BECTS组各导联P3潜伏期明显延长(均P<0.01),波幅明显降低(均P<0.05)。结论频繁的临床下癫样放电可能是造成BECTS儿童数学认知功能障碍的因素之一。     

多项睡眠图联合长程视频脑电图监测癫(痫)患者夜间睡眠呼吸事件82例报告

目的:探讨癫(痫)患者睡眠中(痫)性放电对睡眠呼吸事件的影响.方法:对临床确诊的82例成人癫(痫)患者进行多项睡眠图(PSG)和长程视频脑电图(V-EEG)监测,分析其夜间睡眠中发作性事件情况,并探讨(痫)性放电及抗癫(痫)药的影响.结果:癫(痫)组入睡潜伏期、快速眼动(REM)睡眠潜伏期增加,浅睡期所占比例增多,深睡期所占比例减少,睡眠效率降低,夜间觉醒次数增多,睡眠呼吸暂停指数增高,与对照组比较差异均有显著意义(P＜0.01).周期性腿动事件与对照组比较无明显差异.(痫)性放电和抗癫(痫)药对睡眠呼吸暂停指数和周期性腿动指数未见明确影响.结论:癫(痫)患者存在睡眠结构紊乱和睡眠呼吸障碍,觉醒事件、呼吸事件、腿动事件三者之间相互影响,采用PSG联合V-EEG同步监测有利于全面分析睡眠结构与癫(痫)呼吸事件之间的关系.     

癫(癎)发作同步记录脑电图非典型癫(癎)样病理波发放的临床意义

目的 观察癫(癎)发作时棘、尖样波群以外有别于背景波的θ、δ波在癫(癎)诊断中的价值,正确认识癫(癎)发作同步记录脑电图未见到尖、棘样典型病理波发放的临床意义.方法 对2000-01～2007-01我院收治的具有(癎)样发作患者203例的录像监测脑电图(video-EEG)进行回顾性分析.结果 脑电图正常16例(7.5%),临床发作与典型癫(癎)样病理波同步发放者157例(77.3%),临床发作与非典型癫(癎)样病理波同步发放者30例(15.2%),发作间歇期有癫(癎)样波发放者56例,发作间歇期可见不典型癫(癎)样波发放者36例.结论 正确识别棘、尖波群以外有别于背景波的癫(癎)样波的演变过程及规律,可提高癫(癎)的准确诊断率.     

睡眠剥夺对癫(癎)患儿(癎)波发放及其对正常睡眠波的影响

目的探讨癫患儿在睡眠剥夺(SD)诱发试验中波检出率及波发放对睡眠中顶尖波、睡眠纺锤波的影响。方法对160例不同年龄、临床拟诊为癫的患儿SD后进行清醒及睡眠脑电图检查。结果SD后脑电图癫波检出率睡眠时(59.3%)明显高于清醒时(16.3%)(P<0.01);≥6岁组(82.9%)及2～5岁组(72.0%)癫波检出率高于<2岁组(36.2%)(均P<0.01);≥6个月的137例患儿中,36例纺锤波或顶尖波缺如,其中72.0%出现癫波频繁发放,101例纺锤波、顶尖波正常,仅9.9%出现波频发(P<0.01)。结论SD可明显提高癫患儿癫波的检出率;<2岁的癫患儿癫波检出率低;波频繁发放对正常顶尖波、纺锤波产生抑制作用。     

儿童睡眠中癫(癎)性电持续状态36例临床分析

目的:总结儿童睡眠中癫(癎)性电持续状态(ESES)的临床、脑电图(EEG)、神经心理障碍的特点及对治疗的反应.方法:对36例ESES患儿进行V-EEG监测,随访观察临床、EEG、神经心理障碍的情况以及治疗效果.结果:36例中27例(75%)经治疗临床发作完全控制或明显减少,EEG上ESES消失.22例使用肾上腺皮质激素甲基泼尼松龙冲击治疗中的17例(77%)在临床发作改善和抑制(癎)样放电方面都有良好的疗效.32例神经心理障碍患儿26例(81%)经治疗后有明显改善.结论:ESES是一种特殊的EEG现象,非快速眼动(NREM)睡眠期持续放电是神经心理障碍的主要原因.抗癫(癎)治疗除控制其临床癫(癎)发作外,还必须及早消除EEG(癎)样放电持续状态.     

Orexin受体拮抗剂对睡眠剥夺的戊四氮致(癎)大鼠癫(癎)发作及脑组织病理学变化的影响

目的 探讨orexin-1受体(OX1R)和orexin-2受体(OX2R)拮抗剂对睡眠剥夺(SD)的戊四氮(PTZ)致(癎)大鼠癫(癎)发作及脑组织病理学变化的影响.方法 雄性Wistar大鼠48只,随机分为正常对照(NC)组、PTZ组、SD+ PTZ( SD)组、SD+ PTZ+二甲基亚砜(DMSO)组、SD+ PTZ+ OX1R拮抗剂SB334867(SB)组和SD+ PTZ+ OX2R拮抗剂TCS OX229 (TCS)组.采用改良多平台SD法,SD前及SD 48 h分别给予相应组大鼠侧脑室注射DMSO、SB或TCS.SD 72 h给予各组腹腔注射PTZ 50 mg/kg诱导癫(癎)发作;观察各组大鼠癫(癎)发作的潜伏期、发作等级评分、发作持续时间及死亡率;应用常规染色法观察海马的病理学变化,免疫荧光法(BrdU标记)观察神经细胞增殖的变化.结果 (1)与PTZ组比较,SD组及DMSO组(癎)性发作的潜伏期明显缩短,发作等级评分、持续时间及死亡率明显增加(均P ＜0.001),海马CA3区神经元损害加重,海马齿状回门区和颗粒细胞下层BrdU阳性细胞数显著增多(P＜0.001);SD组与DMSO组间差异无统计学意义.(2)与SD组比较,SB组和TCS组大鼠(癎)性发作的潜伏期明显延长,发作等级评分、持续时间及死亡率明显下降(均P＜0.05),海马CA3区神经元损害明显减轻,齿状回门区和颗粒下层BrdU阳性细胞数减少(均P ＜0.05);TCS组的变化较SB组更显著(P＜0.05 ～0.01).结论 Orexin受体拮抗剂尤其是OX2R拮抗剂可通过减轻海马CA3区神经元的损害和抑制齿状回区细胞增殖减轻SD对PTZ诱导癫(癎)发作的不利影响.     

64例常规清醒脑电图未见癎样放电的小儿癫癎夜间自然睡眠脑电图分析

脑电图(electroencephalography,EEG)是诊断癫癎(epi-lepsy,EP)最重要的辅助检查方法,对发作性症状的诊断有很大价值,有助于明确癫癎的诊断及分型和确定特殊综合征。理论上任何一种癫癎发作都能用EEG记录到发作或发     

脑电图检查对癫(癎)病人致(癎)灶的定位价值

1 临床资料 1.1 一般资料 经临床、影像学及脑电图(EEG)检查,明确诊断为癫(癎)并接受手术者共计96例,其中男60例,女36例,年龄8～49岁,平均28.5岁.发作类型(按1985年中华医学会第一届全国癫(癎)会议确定的标准)为简单部分性发作6例,复杂部分性发作18例,复杂部分性发作伴精神症状6例,全身强直阵孪性发作66例.     

频繁的临床下癫痫样放电对睡眠结构的影响

目的分析临床下癫痫样放电(SED)对睡眠结构的影响。方法对44例伴中央颞区棘波的良性儿童癫痫(BECTS)患者进行脑电-多导睡眠监测研究,并应用非条件Logistic回归分析处理数据。结果BECTS患者的睡眠周期中棘波指数分布为Ⅱ期>Ⅰ期>Ⅲ/Ⅳ期>REM期;BECTS患者的睡眠REM期缩短、Ⅰ期睡眠比例增加、Ⅲ/Ⅳ睡眠比例减少;SED频率与睡眠结构失调发生呈正相关关系。结论频繁的SED(>10次/分)是引起睡眠结构失调的主要危险因素,可以引起睡眠结构的紊乱。     

Benign focal epileptiform discharges of childhood and hippocampal sclerosis

PURPOSE: Benign focal epileptiform discharges of childhood (BFEDCs) are common EEG findings between ages 4 and 14 years. This epoch of maturational development overlaps with the age at presentation of temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in children. METHODS: From our series of 17 preadolescent children who eventually underwent anteromesial temporal resection for medically refractory TLE due to HS, we identified two children, plus one thereafter, who were initially dismissed as candidates for epilepsy surgery because of abundant extratemporal sharp waves, which were bilateral in two cases. The sharp waves had the distinctive morphology, distribution, and sleep activation suggestive of BFEDCs, but the medical intractability and seizure symptoms were unusual for benign focal epilepsy of childhood. RESULTS: In each case, surgical candidacy was clarified when magnetic resonance imaging (MRI) showed unilateral HS and video-EEG demonstrated seizure onset in the ipsilateral anteromesial temporal region. The postoperative freedom from seizures in each case (follow-up, 2 to 4 years) confirmed that HS was the primary epileptogenic process, and that the BFEDCs were incidental or an atypical secondary manifestation. CONCLUSIONS: These cases illustrate the need for more extensive study of children with BFEDCs when medical intractability and seizure symptoms speak against a simple diagnosis of benign focal epilepsy of childhood. In addition, we observed that the BFEDCs in two of our children had an unusual bilateral occipitofrontal distribution, and we speculate that the coexistence of the BFEDCs in children with HS may not be an incidental finding.     

Epileptiform activity in the electroencephalogram of 6-year-old children of women with epilepsy

Purpose:To study the epileptiform discharges (EDs) in the electroencephalogram (EEG) of 6-8-year-old children of women with epilepsy (WWE).Results:Of the 185 children examined, 37 (20%) children (19 males, 18 females) had ED in their EEG. The EDs were generalized in 7 children, and focal in 30 children. The EDs were present in the sleep record only of 16 (43%) children and in the awake record only of 6 (16%) children. Out of the 94 children for whom seizure history was available, 7 children (7.4%) had seizures (neonatal seizures: 4, febrile seizure: 1, and single nonfebrile seizure: 2) and none had history of epilepsy or recurrent nonfebrile seizures. The odds ratio (OR) for occurrence of ED in the EEG was significantly higher for children of WWE [OR = 3.5, 95% confidence interval (CI) 2.3-6.0] when compared to the published data for age-matched children of mothers without epilepsy. There was no association between the occurrence of ED and the children''s maternal characteristics [epilepsy syndrome, seizures during pregnancy, maternal intelligence quotient (IQ)] or the children''s characteristics [antenatal exposure to specific antiepileptic drugs (AEDs), birth weight, malformations, IQ].Conclusion:Children of WWE have a higher risk of epileptiform activity in their EEG when compared to healthy children in the community though none had recurrent seizures.     

伴全面放电的局灶性癫痫的临床特征及手术治疗

目的 探讨伴有全面性发作间期癫痫样放电（GIEDs）的局灶性癫痫患者的临床特征及手术疗效。方法 回顾性分析2011年1月至2014年6月收治的733例MRI显示有局部异常的癫痫患者的临床资料,发作间期出现全导联同步异常放电（包括同时有局灶性异常放电形式）60例（伴GIEDs组）,673例没有这种表现（不伴GIEDs组）。伴GIEDs组中,19例采用手术治疗。结果 伴GIEDs组起病年龄≤12岁比例（80.0%,48/60）明显高于不伴GIEDs组（46.2%,311/673;PPP<0.05）。19例手术治疗患者术后随访1年以上,无明显永久的神经功能损伤,发作控制效果按engel分级:ⅰ级13例,ⅱ级2例,ⅲ~ⅳ级4例。>结论 局灶性癫痫患者可伴有GIEDs,手术治疗或可为该类患者提供一定的获益。     

Effect of levetiracetam in patients with epilepsy and interictal epileptiform discharges

The effect of acute treatment with the new antiepileptic drug (AED) levetiracetam (Keppra) on the frequency of interictal epileptiform discharges (IEDs) was evaluated in a double-blind, placebo-controlled, crossover study with therapeutic drug monitoring and serial electroencephalographic (EEG) observations. Acute (500 mg twice daily) and chronic (individualized, 500-1000 mg twice daily) doses of levetiracetam were administered as an add-on to current AED treatment. Efficacy was tested by measuring the frequency of IEDs in EEG recordings and the number of seizures. A single acute dose of levetiracetam induced a reduction of IEDs in eight out of ten patients. During the acute phase, an insufficient number of seizures occurred for analysis. During chronic treatment over 8 weeks, seven patients showed a reduction in seizure frequency (responder rate), and one patient remained seizure free. No correlation was seen between levetiracetam levels and IED frequency. Doses of levetiracetam of up to 2000 mg/day were well tolerated, and no interactions were seen with concomitant AEDs.     

反复惊厥阈下痫样放电致大鼠持续性情绪唤醒障碍

目的 探讨反复惊厥阈下痫样放电是否可引发实验大鼠较长时间的情绪唤醒障碍.方法 选择6～7周龄雄性SD大鼠62只,成组设计,随机分为惊厥阈下痫样放电组(subelinical epileptifor mdis charges group,SED组,n=16)、海马快速电点燃组(hippoeampal kindling group,HK组,n=16)、海马电极埋植对照组(control of electrode group,EC组,n=15)、正常对照组(normal control group,NC组,n=15),建立大鼠反复SED动物模型,通过运动活性、探究行为、拒俘反应性、高架十字迷宫实验,观测电刺激停止后1、7和30 d时实验大鼠情绪唤醒水平改变.结果 与EC组相比,电刺激后7 d,HK组、SED组大鼠旷场爬越行为明显减少(P<0.01),后肢性站立、进入高架十字迷宫开臂次数百分比和滞留时间百分比降低(P<0.05),电刺激后30 d上述差异仍存在(P<0.05),同时,HK组、SED组大鼠拒俘反应性在电刺激后30 d有明显增加(P<0.01).结论 反复惊厥阈下痫样放电引起了实验大鼠持续性运动活性减少、探究行为受抑、警觉水平过高、焦虑不安状态、环境适应能力下降、惊恐逃避反应等多种情绪唤醒障碍.     

Occurrence of epileptiform activity in the routine EEG of epileptic patients

In a retrospective study, the occurrence of epileptiform activity (EA) in routine EEG records of epileptic patients was investigated. Data were obtained from 1078 EEGs of 373 patients (199 men and 174 women; aged 17-87 (mean 34.2 +/-14.7)). The percentage of 38% of patients with EA in a single EEG could be increased to 77% by repeated records. After the 5th record however, the gain in new information decreased remarkably. No differences between seizure types could be detected. There was a relationship between EA and nonspecific EEG abnormalities. High EA rates were found for short time intervals since last seizure, young patients, long durations of the seizure disorder and for high seizure frequencies.     

Nocturnal epileptiform EEG discharges, nocturnal epileptic seizures, and language impairments in children: review of the literature

This review addresses the effect on language function of nocturnal epileptiform EEG discharges and nocturnal epileptic seizures in children. In clinical practice, language impairment is frequently reported in association with nocturnal epileptiform activity. Vice versa, nocturnal epileptiform EEG abnormalities are a common finding in children with specific language impairment. We suggest a spectrum that is characterized by nocturnal epileptiform activity and language impairment ranging from specific language impairment to rolandic epilepsy, nocturnal frontal lobe epilepsy, electrical status epilepticus of sleep, and Landau-Kleffner syndrome. In this spectrum, children with specific language impairment have the best outcome, and children with electrical status epilepticus of sleep or Landau-Kleffner syndrome, the worst. The exact nature of this relationship and the factors causing this spectrum are unknown. We suggest that nocturnal epileptiform EEG discharges and nocturnal epileptic seizures during development will cause or contribute to diseased neuronal networks involving language. The diseased neuronal networks are less efficient compared with normal neuronal networks. This disorganization may cause language impairments.     

Treatment of interictal epileptiform discharges in cerebral palsy patients without clinical epilepsy: hope for a better outcome in prognosis

Cerebral palsy (CP) is a motor disorder due to cerebral damage. It is commonly associated with neuro-psychological retardation and also with epilepsy; hence, its management warrants a multi-dimensional approach. In a significant number of CP patients, interictal epileptiform discharges (IEDs) are obtained in their EEG even in absence of clinical epilepsy. Epileptiform discharge-firing cortical neurons are found to be associated with elevated intracellular Ca(2+) levels and exhibition of abnormal response on exposure to excitotoxic glutamate; both these features have been found to lead to subsequent death of these neurons. This further damage is likely to aggravate the already existing cortical damage in CP patients thereby worsening their prognosis. IEDs are also known to be associated with other neuro-psychological disorders like cognitive impairment and behavioral problems even in absence of clinical epilepsy. Thus, the IEDs cannot be viewed as benign events and their occurrence even in absence of clinical epilepsy cannot be ignored. A few trials aimed at treating IEDs in autistic patients without epilepsy and in children with behavior problems have yielded favorable results. Based on these studies, the author proposes inclusion of EEG investigation in the management protocol of CP patients and treatment of IEDs (when detected even in absence of clinical epilepsy) for a better outcome in their prognosis.