额叶癫(癎)发作的临床表现及脑电图特征

目的:探讨额叶癫痢发作的临床表现与脑电图特征.方法:对36例额叶癫癎发作患者临床表现及脑电图特征进行同步分析.结果:额叶癫癎发作频繁而短暂,以睡眠中发作为主.常见发作形式为复杂部分性发作,主要表现为过度运动、偏转性强直、姿势性强直、发声及重复语言,额叶失神等.常规脑电图检查阳性率30.6%.长时间视频监测阳性率91.7%.绪论:额叶癫癎发作是-组以运动症状为主的癫癎综合征,临床表现复杂多样,长程视频监测为无创性诊断额叶癫癎发作最佳方法.     

额叶癫癎发作的临床表现及脑电图特征

目的:探讨额叶癫癎发作的临床表现与脑电图特征。方法:对36例额叶癫癎发作患者临床表现及脑电图特征进行同步分析。结果:额叶癫癎发作频繁而短暂,以睡眠中发作为主。常见发作形式为复杂部分性发作,主要表现为过度运动、偏转性强直、姿势性强直、发声及重复语言、额叶失神等。常规脑电图检查阳性率30.6%,长时间视频监测阳性率91.7%。结论:额叶癫癎发作是一组以运动症状为主的癫癎综合征,临床表现复杂多样,长程视频监测为无创性诊断额叶癫癎发作最佳方法。     

具有中央-颞部棘波的良性儿童期癫癎60例临床分析

目的:探讨具有中央-颞部棘波的良性儿童期癫癎(benign childhood epilepsy with cen-tro-temporal spike,BECTS)患儿的临床和脑电图特点.方法:对60例BECTS患儿的资料进行回顾性分析,总结其临床表现、脑电图特点、治疗方法,并随访其预后.结果和结论:45例(75%)表现为刻板的夜间癫癎发作,以一侧面部抽搐、流涎、喉中发声等症状为主.15例(25%)清醒状态下发作.发作期清醒脑电图癎性放电、睡眠脑电图癎性放电出现率分别为10%(6/60)、100%,发作间期清醒脑电图癎性放电、睡眠脑电图癎性放电出现率分别为60%(36/60)、87%(52/60).8例仅发作1次者无需治疗,52例患儿接受丙戊酸或卡马西平治疗,有效50例(96%),治疗2年无发作后即使脑电图未恢复到正常也可减量停药.     

癫(癎)合并非癫(癎)性发作21例漏诊分析

癫(癎)的本质是脑神经元的异常放电,而非癫(癎)性发作(non-epileptic seizure,NES)是指一组临床症状类似于癫(癎)发作的发作性疾病,其发生与脑部电生理紊乱无关,而由于生理或心理功能障碍所致,发作时不伴脑电图(癎)样放电[1].临床上二者极易混淆,当二者并存时更易引起误诊或漏诊.现回顾性分析我院2001年6月～2005年12月确诊为癫(癎)合并NES的21例资料,以探讨临床和脑电图特点,避免漏诊.     

动态脑电图在癫痫定位诊断中的意义

目的探讨动态脑电图(ambulatoryelectroencephalogra-phy,AEEG)对癫痫诊断及定位诊断的临床意义。方法采用常规脑电图、AEEG及双局部密集AEEG对512例有临床发作癫痫患者进行检查,观察及分析脑电变化。结果①常规脑电图,其中136例正常;87例弥散性慢波,未见明显痫样波发放;146例呈弥散性双额颞叶棘波、尖波或棘尖慢综合波,不能准确定位;143例显示一侧额颞部癫痫样波发放。②AEEG检查:根据常规脑电图行AEEG,其中45例正常;48例双侧半球弥散性慢波,未见显著痫样波发放;91例弥散性双额颞叶棘波、尖波或棘尖慢综合波;328例显示一侧额颞部癫痫样波发放。③局部密集AEEG:对139例不能明确定位者检测,其中107例一侧额颞部棘波、尖波或棘尖慢综合波发放显著;15例呈双颞大脑半球棘波或尖波或棘尖慢综合波发放,一侧略显著,但不能准确定位;17例双侧半球弥散性慢波,未见明显痫样波发放。结论采用多形式脑电图尤其是AEEG及局部密集AEEG检查对癫痫的诊断及定位诊断有较大帮助,同时对临床诊治尤其是手术切除癫痫灶有很好的指导意义。     

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。     

动态脑电图在癫痫定位诊断中的意义

目的 探讨动态脑电图(ambulatory electroencephalography，AEEG)对癫痫诊断及定位诊断的临床意义。方法 采用常规脑电图、AEEG及双局部密集AEEG对512例有临床发作癫痫患者进行检查，观察及分析脑电变化。结果 ①常规脑电图，其中136例正常；87例弥散性慢波，未见明显痫样波发放；146例呈弥散性双额颞叶棘波、尖波或棘尖慢综合波，不能准确定位；143例显示一侧额颞部癫痫样波发放。②AEEG检查：根据常规脑电图行AEEG，其中45例正常；48例双侧半球弥散性慢波，未见显著痫样波发放；91例弥散性双额颞叶棘波、尖波或棘尖慢综合波；328例显示一侧额颞部癫痫样波发放。③局部密集AEEG：对139例不能明确定位者检测，其中107例一侧额颞部棘波、尖波或棘尖慢综合波发放显著；15例呈双颢大脑半球棘波或尖波或棘尖慢综合波发放，一侧略显著，但不能准确定位；17例双侧半球弥散性慢波，未见明显痫样波发放。结论 采用多形式脑电图尤其是AEEG及局部密集AEEG检查对癫痫的诊断及定位诊断有较大帮助，同时对临床诊治尤其是手术切除癫痫灶有很好的指导意义。     

外伤性癫痫的临床特征和动态脑电图分析

目的分析和总结外伤性癫痫的临床特征、动态脑电图特点及其临床意义。方法对37例门诊及住院的外伤性癫痫患者的临床特征和动态脑电图资料进行回顾性分析。结果 37例患者中闭合性颅脑损伤29例,开放性颅脑损伤8例;保守治疗20例,行开颅手术17例。外伤性癫痫临床发作类型主要表现为部分性发作及全面性发作,本组单纯部分性发作7例(18.9%);复杂部分性发作21例(56.8%),其中继发全身强直-阵挛性发作15例;单纯强直-阵挛性发作9例(24.3%)。动态脑电图主要表现为脑损伤部位、相邻部位和(或)对冲性部位局限性慢波、尖慢波、棘波或棘慢综合波等,本组表现散在的尖波、棘慢波、棘波等24例(64.9%),13例(35.1%)在脑损伤部位及对冲部位可见痫样放电。结论外伤性癫痫的临床表现和动态脑电图表现复杂多样且具有一定的特征性,正确认识其临床特征和脑电图特点是获得良好治疗效果的关键环节。     

AEEG监测106例婴幼儿癫(癎)性或非癫(癎)性发作的临床意义

发作性疾病或症状在婴幼儿较为常见,临床鉴别癫(癎)或非癫(癎)性发作较为困难.目前24小时动态脑电图(AEEG)的应用,能长程监测病人的临床发作与脑电图的关系,为发作性疾病的诊断和鉴别诊断提供了可靠的依据.我院2002年4月～2005年7月共行AEEG监测婴幼儿256例,监测到发作性疾病106例,占41.4%,现分析报告如下.     

以癲癎样发作为首发表现的内科疾病的临床及脑电图分析

目的:探讨脑电图在诊断以癫癎样发作为首发表现的内科疾病的价值.方法:对48例通过脑电图、CT、核磁共振及实验室检查确诊的以癫癎样发作为首发表现的内科疾病进行回顾性分析,明确脑电图与病因的相关性.结果:脑电图报告正常8例,边缘状态4例,广泛弥漫轻度异常17例,中度异常10例,局限性异常9例,阳性率占75.0%.48例均未见有尖波、棘波等异常放电.结论:以癫癎样发作为首发表现的成年人患者,脑电图表现为不同程度广泛弥漫性慢波和局限性慢波为主时,除考虑癫癎病外,应排除其他内科疾病.综合判断,避免漏、误诊.     

Autonomic epilepsy--the influence of epileptic discharges on heart rate and rhythm.

PURPOSE: To study cardiac alterations (changes in heart rate and cardiac arrhythmias) at the transition from the pre-ictal to the ictal state during focal epileptic seizures. METHODS: We assessed ECG changes during 92 seizures recorded with scalp EEG in 30 patients and 35 seizures in 11 patients evaluated with subdural strip and/or grid electrodes. Consecutive RR intervals were analyzed with a newly developed mathematical model for a total of 90 seconds (60 seconds pre-ictal, 30 seconds ictal). RESULTS: We found an ictal tachycardia (heart rate increase > 10 bpm) in 82.5% of seizures, and an ictal bradycardia (heart rate decrease > 10 bpm) in 3.3% of seizures. Bradycardia was only observed in seizures of frontal lobe origin. Heart rate changes occurred several seconds prior to EEG seizure onset on scalp-EEG in 76.1% of seizures, but also prior to EEG seizure onset on invasive EEG in 45.7% of seizures. Early tachycardia occurred significantly more often in temporal than in frontal lobe origin seizures. We found no significant effect of the side of seizure onset on both the quality and quantity of ictal heart rate changes. The occurrence of an aura or of awakening prior to the seizure had no influence on peri-ictal heart rate changes. Low risk cardiac arrhythmias were more frequently observed in frontal lobe origin seizures. CONCLUSIONS: Epileptic discharges directly influence portions of the central autonomic network, within a brain area too small or too deep to be detected on EEG, most likely deep mesial structures such as the amygdala or portions of the hippocampus. The potential clinical applications of our results include (1) automatic seizure detection, (2) differentiation between seizures of temporal and frontal lobe origin, (3) detection of peri-ictal cardiac arrhythmias, and (4) clarification of SUDS (sudden unexplained death syndrome) in epilepsy.     

Characteristics of postictal headache in patients with partial epilepsy

Migraine-like features sometimes characterize the headache that follows epileptic seizure (postictal headache, PIH). We compared patients with different types of epilepsy to investigate the association between migraine-like PIH and seizure type. Subjects comprised 364 patients with partial epilepsy. Epilepsy types were temporal lobe epilepsy (TLE, n = 177), frontal lobe epilepsy (FLE, n = 116), and occipital lobe epilepsy (OLE, n = 71). Patients participated in a structured interview pertaining to PIH as well as interictal headache and family history of migraine. Headaches were classified according to the International Headache Society criteria, which was modified for this study. Forty percent had PIH and 26% of these patients had migraine-like PIH. Migraine-like PIH occurred significantly more often in cases of TLE and OLE than in cases of FLE. In addition, the incidence of interictal migraine headache was significantly higher in patients with migraine-like PIH. These results suggest that migraine-like PIH is related to particular regions of epileptogenic focus and that susceptibility to migraine headache predisposes to migraine-like PIH.     

脑卒中后癫痫发作的临床研究

目的　研究脑卒中后癫痫发作病人的临床分型及其与原发病和病灶部位的关系,评价脑电图、CT、MRI对癫痫的诊断价值以及治疗的效果。方法　收集门诊、病房几年来治疗的脑卒中合并癫痫发作的病人 68 例,按癫痫发作的时间和临床表现分型。每例病人均做CT、MRI和EEG。结果　本资料中,早期型癫痫22例(32%),迟发型癫痫46例(68%)。癫痫发作类型以额叶癫痫最常见。脑梗死及多发病灶患者占多数。药物治疗控制发作效果较好。脑电图能反映病情变化,病情控制后,脑电图也逐渐好转。而 CT、MRI对病灶的定位不能反映癫痫的类型。结论　额叶癫痫最常见,多发病灶易致癫痫发作。脑电图对癫痫的诊断和判断癫痫的控制有帮助,CT、MRI无助于癫痫的分型和治疗的评价。药物治疗效果较好。     

Epilepsy surgery, resection volume and MSI localization in lesional frontal lobe epilepsy

To verify whether interictal noninvasive information detected by magnetoencephalography (MEG) recordings can contribute to localize focal epileptic activity relevant for seizure generation in lesional frontal lobe epilepsy, magnetic source imaging (MSI) localizations of epileptic discharges were compared to the extent of neurosurgical resection and postoperative outcome. Preoperative MEG spike localizations were displayed in postoperative magnetic resonance imaging (MRI) scans to check whether dipole sites were located within the resection cavity. Moreover, MEG localizations were compared with results of prolonged video-EEG monitoring and, in three cases, with invasive EEG recordings. Our results in five cases with lesional frontal lobe epilepsy showed that good surgical outcome could be achieved in those patients where the majority of MEG spike localizations were located within the resected brain volume.     

Frontal lobe epilepsy--clinical seizure seminology

The aim of this study was an analysis of the localizing and lateralizing value of clinical symptoms in frontal lobe epilepsy. Nineteen patients with medically refractory seizures originating from the frontal lobe were examined retrospectively, seven of these patients underwent subsequent neurosurgical removal of the epileptogenic zone. The predominant clinical symptoms were clonic (53%) and tonic motor phenomena (89%). Dystonic posturing (32%) and postictal paresis (37%) occurred frequently, indicating a seizure onset in the contralateral hemisphere. Head version contralateral to the seizure onset zone, as demonstrated in 53% of the patients, was a reliable lateralizing sign, whereas early head and eye turning (11%) had no lateralizing significance. 37% of the patients showed ictal vocalisation, another 37% presented with automatisms--so called hypermotor seizures should be considered as a special subtype. An aura was present in 26% of the patients--in most cases as a somatosensory manifestation or a feeling of dizziness, especially with seizures originating from the supplementary motor area (SMA) or the precentral area. Secondary generalization and seizure series occurred frequently. Unilateral automatisms, head version, tonic phenomena, dystonic posturing, unilateral grimacing, postictal paresis and unilateral clonic movements could be identified as reliable lateralizing signs. We conclude that the analysis of clinical symptoms plays an important role in presurgical epilepsy diagnosis.     

功能磁共振观察额叶癫痫患者静息态局域一致性

目的 探讨静息状态下额叶癫痫(FLE)患者局域一致性(ReHo)的变化特点.方法 对46例常规结构MRI阴性FLE患者及性别年龄无差异的正常对照组行静息态fMRI,比较 ReHo改变脑区,观察ReHo改变脑区与FLE病程长短的相关性.结果 相比正常对照组,FLE患者ReHo值升高的脑区包括前、中扣带回,双侧岛叶、丘脑及右侧基底核区,ReHo降低脑区包括左侧额上回,左侧颞中、下回及小脑.相关性分析结果显示,FLE患者前、中扣带回,额上回ReHo值与病程长短呈正相关,双侧辅助运动区、右侧枕叶ReHo值与病程呈负相关.结论 FLE患者静息态下脑功能异常,扣带回、岛叶、丘脑及基底核区等区域存在ReHo改变.     

Localizing epileptogenic regions in partial epilepsy using three-dimensional statistical parametric maps of background EEG source spectra

This preliminary study sought to localize epileptogenic regions in patients with partial epilepsy by analysis of interictal EEG activity utilizing variable resolution electromagnetic tomography (VARETA), a three-dimensional quantitative electroencephalographic (QEEG) frequency-domain distributed source modeling technique. The very narrow band (VNB) spectra spanned the frequency range 0.39 Hz to 19.1 Hz, in 0.39 Hz steps. These VNB spectra were compared to normative data and transformed to provide Z-scores for every scalp derivation, and the spatial distributions of the probable EEG generators of the most abnormal values were displayed on slices from a probabilistic MRI atlas. Each voxel was color-coded to represent the significance of the deviation relative to age appropriate normative values. We compared the resulting three-dimensional images to the localization of epileptogenic regions based on invasive intracranial EEG recordings of seizure onsets. The VARETA image indicated abnormal interictal spectral power values in regions of seizure onset identified by invasive monitoring, mainly in delta and theta range (1.5 to 8.0 Hz). The VARETA localization of the most abnormal voxel was congruent with the epileptogenic regions identified by intracranial recordings with regard to hemisphere in all 6 cases, and with regard to lobe in 5 cases. In contrast, abnormal findings with routine EEG agreed with invasive monitoring with regard to hemisphere in 3 cases and with regard to lobe in 2 cases. These results suggest that analysis of background interictal EEG utilizing distributed source models should be investigated further in clinical epilepsy.     

What is the significance of interictal water diffusion changes in frontal lobe epilepsies?

The aim of this study was to better understand the significance of interictal changes in water molecule diffusivity defined by diffusion-weighted imaging (DWI) in frontal lobe epilepsy (FLE), as well as to test the accuracy of interictal DWI in the definition of the epileptogenic zone (EZ). DWI was carried out in 14 patients with refractory FLE (9 negative-MRI) as well as in 25 controls. Statistical mapping analysis (SPM2) of diffusivity maps was used to detect, for each subject, significant diffusivity alterations. We then studied the relationships between diffusion and depth recorded electrical abnormalities. Clinical correlates of the extent of diffusivity changes were also tested. We found areas of significantly increased diffusivity (SID) in 13 patients. Eight had SID in the EZ, 9 within the irritative zone (IZ) and 12 outside, mainly in connected areas. We found a correlation between the extent of SID and the duration of epilepsy (p corrected=0.026, R=0.621). In addition, SID was significantly less widespread in negative-MRI patients (p=0.028). However, we found no significant differences concerning either seizure frequency (p=0.302), seizure generalization (p=0.841), history of status (p=0.396), or surgical outcome (p=0.606). We suggest that SID in normal appearing areas is not a specific signature of epileptogenicity in FLE, and is more likely to reflect multifactorial and potentially evolving neuro-glial injuries.     

颞叶蛛网膜囊肿伴癫痫患者的临床相关特点

目的探讨伴有癫痫的颞叶蛛网膜囊肿(AC)患者的相关临床特征,以及颞叶AC与癫痫发作类型、脑电图异常之间关系。方法选取2012年12月至2019年5月在唐都医院神经外科癫痫组就诊的64例颞叶AC合并癫痫患者为研究对象。将所有患者按照囊肿类型、囊肿大小及癫痫类型、脑电图类型进行分类,并分析其相互关系。结果各年龄组及总体患者中,男性占比高于女性。在三种囊肿类型、两种不同大小的囊肿及总体患者中,全面性起源的癫痫为最多的类型,未知起源的癫痫为最少的类型;脑电异常患者占比远高于脑电正常患者占比,间期脑电异常均以广泛性为主。三种囊肿类型、两种不同大小的囊肿和癫痫、脑电图类型之间不存在统计学关联及差异。结论颞叶AC伴癫痫的患者中,男性多于女性,全面性起源的癫痫和广泛性异常脑电图最常见。囊肿类型、大小与癫痫、脑电图类型之间无明显相关性。     

Anticonvulsant drugs effective against human temporal lobe epilepsy prevent seizures but not neurotoxicity induced in rats by quinolinic acid: electroencephalographic, behavioral and histological assessments

Intrahippocampal injection of quinolinic acid (QUIN) in rats caused an epileptic-like syndrome reminiscent of human temporal lobe epilepsy. By electroencephalographic (EEG) analysis, the authors assessed whether QUIN seizures were responsive to anticonvulsants effective in the treatment of the human disease. Anticonvulsants used in clinical practice to control partial seizures, such as carbamazepine, diphenylhydantoin, sodium phenobarbital, sodium valproate and diazepam, prevented QUIN-induced EEG seizures, whereas ethosuximide, which is specifically used to control absence attacks, and chlorpromazine, a sedative with no anticonvulsant properties, were ineffective. QUIN seizures showed particular sensitivity to carbamazepine (5 mg/kg) but were resistant to diphenylhydantoin unless a relatively high dose was used (100 mg/kg). None of the effective anticonvulsants completely suppressed EEG paroxysmal events like spikes and fast activity. Animals injected with QUIN displayed chewing, sniffing and rearing; no clear correlation was found between the ability of drugs to prevent QUIN-induced EEG seizures and effects on stereotypies, suggesting that these behavioral signs are not sensitive measures of anticonvulsant activity in this model. The anticonvulsants that protected animals from QUIN seizures did not prevent nerve cell degeneration induced by the excitotoxin, thus indicating that nerve cell death can occur even in the absence of sustained seizure activity. The data show that, in this animal model of epilepsy, the EEG seizure activity is specifically sensitive to anticonvulsants effective in partial epilepsy, thus suggesting that it could be used to test potential new drugs for this human disorder.