癫痫患者动态脑电图与常规脑电图的对比分析

目的 :探讨癫痫患者 2 4小时动态脑电图 (AEEG)监测的价值。方法 :对 2 0 4例癫痫患者进行 2 4小时AEEG监测。并与常规 EEG作自身对比。结果 :AEEG异常 15 9例 (78% )。EEG异常 73例 (35 % )。结论 :癫痫患者 2 4小时 AEEG监测对临床诊断有重大意义。     

312例动态脑电图与常规脑电图对比分析

方法:312例患者分成3组:A组症状性癫(疒间)28例,B组原发性癫(疒间)234例,C组发作性症状50例。作AEEG与REEG对比分析。结果:A组(疒间)样放电,局灶性异常率AEEG分别为67.68%,78.57%高于REEG28.57%,39.29%。B组(疒间)样放电,局灶异常AEEG分别为67.52%,64.96%也明显高于REEG29.06%,35.47%。C组局灶异常AEEG36%高于REEG16%。在AEEG监测过程中,10例有临床发作。B组158例AEEG有(疒间)样放电,122例(65.59%)出现于睡眠中,其中114例次(93.44%)在NREM Ⅰ,Ⅱ期。结论:AEEG能提高癫(疒间)确诊率。     

卒中后癫痫发作与卒中后癫痫

卒中是引起癫痫的常见原因,本文就卒中后癫痫发作和卒中后癫痫的定义、发病机制、卒中后癫痫发作类型、癫痫发作的影响因素及治疗进展等做一综述。     

动态脑电图对癫痫的诊断价值

目的探讨动态脑电图(ambulatory electroencephalogram,AEEG)对癫痫(epilepsy,EP)的诊断价值。方法应用奥地利EMS16道脑电记录仪对54例临床诊断为癫痫(常规脑电图均未发现痫样放电)的患者,进行动态脑电图监测。结果①经AEEG检查有痫样放电者44例,阳性率81.5%;②有临床发作者37例(68.5%),其中30例(55.6%)同时出现痫性放电;3例(5.6%)发作期无痫样放电,发作间期脑电图显示痫样放电;4例(7.4%)发作期和发作间期均没有痫样放电;③17例(31.5%)未监测到临床发作,其中11例(20.3%)有痫样放电;6例(1.1%)无痫样放电。结论AEEG监测对癫痫的诊断具有重要价值。     

卒中后癫痫发作的临床研究

目的 研究卒中后癫痫发作的患病率、临床表现与卒中后癫痫的危险因素.方法 对华山医院神经内科自2003年9月1日至2006年2月1日因卒中住院的患者445例进行同顾性研究并对其进行随访.结果 本研究中约9.1%(40例)卒中患者出现卒中后癫痫发作.脑出血、蛛网膜下腔出血、皮层病灶、病灶范围大于一个脑叶的卒中患者更容易出现卒中后癫痫发作(P相似文献   

动态脑电图在癫痫诊断中的应用价值

目的 探讨动态脑电图在癫痫诊断中的应用价值。方法记录169例临床拟诊癫痫患者的24h脑电活动,与常规脑电图检查进行对比。结果动态脑电图痢样放电率（62．72％）及总异常率（86．98％）与常规脑电图比较差异有统计学意义（P均〈0．01）。睡眠期痫样放电率明显高于清醒期。结论24h动态脑电图可提高痫样放电的检出率,对癫痫的诊断有重要应用价值。     

动态脑电图监测对癫痫诊断和鉴别癫痫的意义

目的 探讨24小时动态脑电图（AEEG）对癫痫诊断和鉴别诊断的意义。方法 对235例临床诊断为癫痫及121例非癫痫性发作性疾病患者的AEEG资料进行回顾性分析。结果 癫痫组中AEEG与EEG的异常及癫样放电检出率均有非常显著性差异（P＜0．001）。癫痫组与非癫痫组之间AEEG异常率和痫样放电检出率均有显著性差异（P＜0．05）。AEEG描记中睡眠期痫样放电检出率比清醒期增加15．6％,且57．8％出现在非快速眼球运动睡眠（NREM）Ⅰ～Ⅱ期。结论 AEEG对癫痫诊断、鉴别诊断和指导治疗有重要作用。     

205例癫痫患者动态脑电图分析

资料与方法 205例患者来自本院门诊和住院部，经临床确诊。其中男132例，女73例，年龄2—71岁，平均（25．2±3．1）岁；病程1d～28年，平均（8．3±1．9）年；发作1次／年～13次，d，平均（6．3±2．1）次／年。按国际防治癫痫联盟提出的分类，单纯部分性发作18例，复杂部分性发作37例，部分性发作继发全身发作75例，失神发作36例，肌痉挛性发作14例，全身强直阵挛发作7例，     

24h动态脑电图在癫痫诊断及鉴别中的应用

目的探讨24 h动态脑电图(AEEG)在癫痫诊断及与其他非癫痫发作性疾病鉴别中的应用。方法对683例临床确诊癫痫及295例非癫痫发作性疾病患者的AEEG检查资料进行回顾性分析。结果癫痫组AEEG共记录异常痫性放电443例(64．86%),非特异性异常91例(13．32%),总异常者534例(78．18%)。非癫痫组AEEG发现异常痫性放电26例(8．81%)、非特异性异常38例(12．88%),总异常者64例(21．79%)。两组AEEG在总异常率比较、痫性放电率方面比较均有显著性差异(P＜0．001)。结论AEEG对癫痫及非癫痫发作性疾病有重要鉴别意义,尤其发作期脑电改变更有助于二者的鉴别。     

神经外科患者癫痫反复发作处理分析

目的 探讨神经外科患者出现癫痫反复发作的临床特点、处理原则与方法.方法 回顾性分析沈阳军区总医院神经外科自2011年1月至6月收治的9例癫痫反复发作患者的临床资料,分析其加重的原因、发作特点及治疗方法和结果.结果 9例患者中3例合并胶质瘤、1例蛛网膜囊肿、1例海绵状血管瘤、1例脑软化灶;7例有癫痫病史,2例既往无癫痫病史;7例为额叶癫痫,2例颞叶癫痫.癫痫发作加重的原因:减药3例,新诊断的脑肿瘤2例,手术(颅内电极置入术)1例,原因不明3例.癫痫发作类型包括部分性发作与全面性发作,发作频率从间隔3min至间隔数小时发作一次.患者经给予多种抗癫痫药物联合用药治疗,包括口服与注射给药,癫痫得到控制,其中添加左乙拉西坦口服有较好的疗效.结论 神经外科患者出现癫痫反复发作多呈药物难治性,发作不易控制,其处理应使用对部分性癫痫发作有较好疗效的多种抗癫痫药物联合用药,剂量应高于常规初始剂量,包括静脉注射及肌注给药,以尽快控制癫痫发作.左乙拉西坦因口服吸收快、起效迅速及有较好的抗癫痫作用,对癫痫反复发作有较好的疗效.     

Systematic prolonged video-electroencephalograms identify electrographic seizures in 5% of acute stroke patients with aphasia

In stroke units, diagnosing seizures may be difficult, especially in aphasic patients. We discuss herein our systematic 4-hour video EEG monitoring of 61 patients with aphasia within the first 72 hours after the onset of ischaemic stroke. Five electrographic seizures were identified in 3 patients, with no clinical signs apparent on the video and no symptoms reported by patients. We did not record status epilepticus nor generalized seizure. Comparative analyses disclosed a higher risk of early seizures in patients with haemorrhagic transformation. Video EEG monitoring detected electrographic seizures in 5% of stroke patients with aphasia. This monitoring could be useful for selected patients, especially those with haemorrhagic transformation.     

Noninvasive dynamic imaging of seizures in epileptic patients

Epileptic seizures are due to abnormal synchronized neuronal discharges. Techniques measuring electrical changes are commonly used to analyze seizures. Neuronal activity can be also defined by concomitant hemodynamic and metabolic changes. Simultaneous electroencephalogram (EEG)‐functional MRI (fMRI) measures noninvasively with a high‐spatial resolution BOLD changes during seizures in the whole brain. Until now, only a static image representing the whole seizure was provided. We report in 10 focal epilepsy patients a new approach to dynamic imaging of seizures including the BOLD time course of seizures and the identification of brain structures involved in seizure onset and discharge propagation. The first activation was observed in agreement with the expected location of the focus based on clinical and EEG data (three intracranial recordings), thus providing validity to this approach. The BOLD signal preceded ictal EEG changes in two cases. EEG‐fMRI may detect changes in smaller and deeper structures than scalp EEG, which can only record activity form superficial cortical areas. This method allowed us to demonstrate that seizure onset zone was limited to one structure, thus supporting the concept of epileptic focus, but that a complex neuronal network was involved during propagation. Deactivations were also found during seizures, usually appearing after the first activation in areas close or distant to the activated regions. Deactivations may correspond to actively inhibited regions or to functional disconnection from normally active regions. This new noninvasive approach should open the study of seizure generation and propagation mechanisms in the whole brain to groups of patients with focal epilepsies. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.     

老年人卒中后痫样发作现象的调查研究

This prospective study sought to investigate the clinical,radiological and electroencephalographic(EEG) characteristics of seizures in elderly stroke patients,and their outcomes.Over a 2-year study period,158 consecutive elderly patients with stroke were examined and followed up.Of these patients,32(20%) developed seizures,primarily related to stroke,within a follow up period between 5 months and 2 years.Of these 32 cases,20 experienced infarctions,and 12 experienced hemorrhages.Involvement of cortical regions was detected in most of the patients exhibiting seizures.In these patients,44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography(CT) images.Twenty-five patients(78%) developed early seizures(within 2 weeks after stroke),and half exhibited immediate post-stroke seizures.None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy,while 57% of late onset seizures(four cases) developed epilepsy.No specific EEG patterns were apparent in those who later developed epilepsy.Overall,early onset seizures after stroke were found to be relatively common,and did not affect outcome.Late onset seizures were less common,but were associated with chronic epilepsy.     

Similar semiology of epileptic and psychogenic nonepileptic seizures recorded during stereo-EEG

We report two adolescents with refractory seizure disorders in whom both epileptic and psychogenic nonepileptic seizures (PNES) were recorded with intracerebral EEG. The ictal phenomenology of epileptic seizures (ES) and PNES, consisting of hypermotor attacks in the first patient and left-sided painful episodes in the second patient, proved remarkably similar in both cases, highlighting the difficulties which can arise with the distinction of epileptic seizures and PNES based on ictal phenomenology alone.     

卒中后早期痫性发作危险因素分析及卒中急性期治疗对早期痫性发作的影响

目的探讨卒中后早期痫性发作患者发病的影响因素及卒中急性期治疗对其发病率的影响。方法入选患者均为首次发生缺血性卒中并且无癫痫病史且于2014. 9至2017. 2于中国医科大学附属第一医院住院的患者。经过调取入院病志及电话随访,确定入组患者并进行临床资料的收集。Logistic回归用于评估卒中后早期痫性发作的影响因素及卒中急性期治疗对其的影响。结果共有1224例患者入组,其中28例(2. 3%)患者出现卒中后早期痫性发作。经单因素分析,在TOAST分型、美国国立卫生研究院卒中量表评分(NIHSS评分)、病灶累及皮质及急性期使用药物(抗血小板药物、他汀类药物和降压药物)方面两组间比较,差异有统计学意义(P 0. 05)。经Logistic多因素回归分析,卒中后早期痫性发作与病灶累及皮质(OR=2. 494,95%CI 1. 094～5. 686),急性期使用抗血小板药物(OR=0. 177,95%CI 0. 047～0. 657)、他汀类药物(OR=0. 145,95%CI 0. 051～0. 418)、降压药物(OR=0. 337,95%CI 0. 123～0. 921)方面两组间比较,差异具有统计学意义(P 0. 05)。结论病灶累及皮质的缺血性卒中更容易发生卒中后早期痫性发作。缺血性卒中急性期应用抗血小板药物、他汀类药物及降压药物治疗或许可以降低卒中后早期痫性发作的发病率。     

Pathogenesis of epileptic seizures and epilepsy after stroke

Stroke is an important cause of seizures and epilepsy in adults, particularly among the elderly. The incidence of stroke increases yearly as life expectancy increases and the number of patients with post-stroke seizures and epilepsy is also rising. Post-stroke epilepsy accounts for nearly 50% of newly diagnosed epilepsy among patients over 60 years of age. With increasing stroke awareness and advanced treatments, increased attention is paid to post-stroke seizures and epilepsy including its diagnosis and treatment. There has been a plethora of research on the pathogenesis of seizures and epilepsy after stroke. And thus, the research advances in the pathogenesis and related therapeutic targets of post-stroke seizures and epilepsy will be reviewed in this article.     

Noninvasive detection of focal seizures in ambulatory patients

Reliably detecting focal seizures without secondary generalization during daily life activities, chronically, using convenient portable or wearable devices, would offer patients with active epilepsy a number of potential benefits, such as providing more reliable seizure count to optimize treatment and seizure forecasting, and triggering alarms to promote safeguarding interventions. However, no generic solution is currently available to reach these objectives. A number of biosignals are sensitive to specific forms of focal seizures, in particular heart rate and its variability for seizures affecting the neurovegetative system, and accelerometry for those responsible for prominent motor activity. However, most studies demonstrate high rates of false detection or poor sensitivity, with only a minority of patients benefiting from acceptable levels of accuracy. To tackle this challenging issue, several lines of technological progress are envisioned, including multimodal biosensing with cross-modal analytics, a combination of embedded and distributed self-aware machine learning, and ultra–low-power design to enable appropriate autonomy of such sophisticated portable solutions.     

Frequency and characteristics of early seizures in Chinese acute stroke

We retrospectively studied 1200 hospitalized acute strokes of all etiologies between July 1990 and August 1992. Ninety-six % of all strokes underwent computed tomography of the head. Fifty-eight percent of the 1200 strokes were brain infarction, 32% brain hemorrhage, 6% subarachnoid hemorrhage and 4% were other stroke subtypes. Thirty (2.5%) of all strokes suffered from early seizures. The incidences of early seizures were 2.8% in brain hemorrhage, 2.3% in brain infarction, 2.7% in subarachnoid hemorrhage and 2% in other stroke subtypes. Early seizures were documented in 6% of the patients with carotid territory cortical infarctions and 12% of the patients with lobar hemorrhage, whereas only 0.6% of the patients without carotid territory cortical infarctions and 0.6% of the patients without lobar hemorrhage were affected. Sixty- six percent of 30 early seizures were partial seizures, 24% generalized and status epilepticus were seen only in 10%. In conclusion, we found the early seizure incidence was 2.5% in Chinese patients hospitalized with acute strokes. There was no correlation between seizure occurrence and stroke subtypes. Early seizure developed significantly higher in acute stroke patients with lesions of the cortex than those patients without cortical involvement. The partial seizures were the most frequent type occurring in 66% of all acute stroke patients with early seizures.     

A case of malignant migrating partial seizures in infancy as a continuum of infantile epileptic encephalopathy

The syndrome of malignant migrating partial seizures in infancy (MMPSI) is characterized by onset before the age of 6 months, nearly continuous electrographic seizures involving multiple independent areas of onset in both hemispheres, and poor developmental outcome. This report presents a case involving a patient with MMPSI, who later developed West syndrome. At the age of 2 months old, he showed multifocal partial seizures, which were refractory to antiepileptic drugs. His electroencephalogram (EEG) revealed characteristic migrating multifocal epileptiform activities and neuroimaging finding was normal. The focal seizures were refractory to antiepileptic drugs and ketogenic diet. When he was 9 months old, epilepic spasms were observed with hypsarrhythmia on EEG. He also showed severe developmental delay. MMPSI may be a continuum of infantile epileptic encephalpathy and could evolve to West syndrome.