病毒性脑炎急性期继发癫痫的临床特点

目的:分析病毒性脑炎急性期继发癫痫的临床特点。方法:1982年4月5日～2003年12月15日连续住院的374例病毒性脑炎患者,采用统一的调查表,用Microsoft Access 2002建立数据库,共51个主项内容,部分主项有下属分项。分析患者癫痫发病情况,对比观察继发癫痫患者和无癫痫发作患者脑电图结果及预后情况。结果:374例中115例(30.8％)继发癫痫,其中全面发作72例(62.6％),单纯部分发作18例,复杂部分发作11例,部分继发全面14例。115例患者中23例(20.0％)出现癫痫持续状态,14例(12.2％)继发多系统损害,普通脑电图检查20例发现痫性放电,占17.4％。继发癫痫组额叶、颞叶损害共54例,占47.0％。继发癫痫组与无癫痫发作组比较,脑电图异常程度差异有显著意义(x2=23.6,P<0.01),大脑皮质损害发生率差异有显著意义(x2=85.53,P<0.001)。继发癫痫组住院天数26.1±23.6,无癫痫发作组住院天数17.9±5.0,二者比较差异有显著意义(t=5.33,P<0.001)。结论:急性病毒性脑炎后继发癫痫发作以全面发作最为常见,大脑皮质损害易于继发癫痫,癫痫发作影响病毒性脑炎患者病情恢复。     

病毒性脑炎与癫痫

病毒性脑炎常伴发癫痫。我们对近年来收治的病毒性脑炎作一回顾性研究,癫痫伴发率为62.69％,大多是大发作,且提示脑炎症状达高峰前出现癫痫发作的病例预后较好,反之则差;单纯疱疹病毒性脑炎较其他病毒性脑炎影像学检查异常率高,伴发癫痫率并不高。     

CT、MRI和EEG对病毒性脑炎的诊断价值

目的探讨CT、MRI和EEG对病毒性脑炎的诊断价值。方法回顾性分析137例病毒性脑炎的临床资料，统计CT、MRI和EEG阳性率检查结果。结果137例全部检测分析。（1）CT的检出阳性率16、8％，MRI为76．4％，EEG为85．12％；（2）MRI与CT比较，两者检出阳性率有显著性差异（x^2=65．56，P〈0.005），EEG与CT比较栓出阳性率有显著性差异（x^2=81．55，P〈0.005）；EEG与MRI比较检出阳性率无差异（x^2=0．34，P〉0．05）。结论MRI和EEG检查对病毒性脑炎的诊断价值较大，病毒性脑炎做CT无多大意义。     

急性期病毒性脑炎患儿临床特点及对继发癫痫的影响

目的探讨急性期病毒性脑炎(VE)患儿临床特点,并分析影响继发癫痫(SEP)的相关因素。方法收集2014-06—2017-06就诊于郑州大学附属儿童医院的76例急性期VE患儿的临床资料,对患儿临床特点进行统计分析,采用Logistic回归模型分析影响急性期VE后SEP的危险因素。结果76例患儿中21例出现SEP,发生率为27.6%。单因素分析显示,VE后SEP组急性发作时出现癫痫持续状态、发作次数>10次的比例均明显高于非SEP组(P<0.05),急性期后继续服用抗癫痫药物(AEDs)比例明显低于非SEP组(P<0.05)。多因素Logistic回归分析显示,急性期出现癫痫持续状态(OR=1.570)、发作次数>10次(OR=1.988)是VE后发生SEP的危险因素(P<0.05),急性期后使用AEDs(OR=0.725)是VE后发生SEP的保护因素(P<0.05)。结论VE患儿SEP发生率较高,癫痫持续状态、发作次数>10次是SEP发生的独立危险因素,建议急性期继续予以AEDs以预防SEP发生。     

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。     

病毒性脑炎后继发性癫痫的临床特点及药物疗效分析

最高.经正规抗癫痫治疗,仍有45%的患者为难治性癫痫.结论 脑炎是继发性癫痫的重要病因,其癫痫以颞叶癫痫最为常见,LEV疗效较好,患者长期预后不良.     

以癫痫为首发表现的病毒性脑炎57例临床分析

1 临床资料 1．1 一般资料 男26例，女31例，男女比例为1：1．2，年龄15—62岁，平均32岁。农村患者40例(70％)，城镇17例(30％)；夏、冬两季发病多见(69．6％)，起病至入院时间2—21d，平均18．8d．住院天数15～121d，平均28．2d。     

单纯疱疹病毒性脑炎的临床和EEG研究

目的：研究单纯疱疹病毒性脑炎（HSE）的临床特点及脑电图（EEG）的表现。方法：对25例HSE患者通过汇总分析发现临床与EEG的变化。结果：HSE患者病前多有上感样症状,急性或亚急性起病,精神症状和癫痫发作为其主要表现。结论：EEG在病程中有明显的变化特点。     

病毒性脑炎的脑电图与临床

分析了近十年诊治的１００例病毒性脑炎患者的临床与脑电图关系。结果表明：病毒性脑炎脑电图异常率较高，其异常与以下几个方面有关；（１）病情严重性。（２）脑脊液压力，蛋白含量和细胞数。（３）意识障碍，以及（４）预后。本文资料提示脑电图异常有助于判断病毒性脑炎患者的病情和预后，对定位亦有一定帮助。     

高压氧治疗对病毒性脑炎患者EEG改变的研究

目的 :探讨高压氧 (HBO)治疗病毒性脑炎 (病脑 )前后的EEG变化。方法 :观察HBO治疗病脑 3 2例前后EEG结果 ,进行对比分析。结果 :HBO治疗前EEG异常率为 87 5 % (2 8/3 2例 ) ,HBO治疗后有 14例EEG恢复正常 ,10例EEG异常显著改善 ,4例EEG异常无变化。EEG好转率为 85 71% (2 4/2 8例 ) ,具有统计学意义 (P <0 0 1)。结论 :HBO是一种治疗病脑的有效方法 ,EEG检查对病脑的疗效判断及预后分析有重要意义     

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。     

84例病毒性脑炎的脑电图、脑脊液、头颅CT及临床分析

目的　回顾分析脑电图对病毒性脑炎的早期协助诊断价值以及脑电图结合脑脊液、头颅CT及临床资料对病毒性脑炎的早期诊断价值。方法　分析治愈的 84例病毒性脑炎患者住院 2 4h内的脑电图、腰穿结果 (脑压、脑脊液外观、常规、生化检查 )、头颅CT以及复查的腰穿结果及临床资料。结果　 84例病毒性脑炎患者住院 2 4h内的脑电图异常 77例 ,其中 9例腰穿正常 ;同期腰穿异常结果中以脑压增高例数最多 ( 68例 ) ,其EEG均不正常。EEG和腰穿的检出结果比较有非常显著性差异 ( χ2 =7 11,P <0 0 1) ;头颅CT异常 3 2例。 84例CSF的糖和氯化物初查及复查均正常。临床症状以头痛 ( 82例 )、发热 ( 76例 )最常见。结论　脑电图对病毒性脑炎的早期协助诊断有重要价值。以发热头痛为主症而且脑电图异常 ,结合CSF的压力、细胞数、蛋白的增高、氯化物正常、糖正常或偶有轻度增高及典型病史 ,病毒性脑炎的诊断基本可以确定     

Viral encephalitis and epilepsy

Viral encephalitis presents with seizures not only in the acute stage but also increases the risk of late unprovoked seizures and epilepsy. Acute symptomatic and late unprovoked seizures in different viral encephalitides are reviewed here. Among the sporadic viral encephalitides, Herpes simplex encephalitis (HSE) is perhaps most frequently associated with epilepsy, which may often be severe. Seizures may be the presenting feature in 50% patients with HSE because of involvement of the highly epileptogenic frontotemporal cortex. The occurrence of seizures in HSE is associated with poor prognosis. In addition, chronic and relapsing forms of HSE have been described and these may be associated with antiepileptic drug-resistant seizures. Among the epidemic (usually due to flaviviruses) viral encephalitides, Japanese encephalitis (JE) is most common and is associated with acute symptomatic seizures, especially in children. The reported frequency of acute symptomatic seizures in JE is 7–46%. Encephalitis due to other flaviviruses such as equine, St. Louis, and West Nile viruses may also manifest with acute symptomatic seizures. In Nipah virus encephalitis, seizures are more common in relapsed and late-onset encephalitis in comparison to acute encephalitis (4% vs. 1.8%). Other viruses like measles, varicella, mumps, influenza, and entero-viruses may cause seizures depending on the area of brain involved. There is no comprehensive data regarding late unprovoked seizures in different viral encephalitides. Prospective studies are required to document the risk of late unprovoked seizures and epilepsy following viral encephalitis due to different viruses as well as to determine the clinical characteristics, course, and outcome of post-encephalitic epilepsy.     

Routine EEG and Temporal Lobe Epilepsy: Relation to Long-Term EEG Monitoring, Quantitative MRI, and Operative Outcome

Summary: Purpose: To investigate the relation among routine EEG, long-term EEG monitoring (LTM), quantitative magnetic resonance imaging (MRI), and surgical outcome in temporal lobe epilepsy (TLE).
Methods: We evaluated 159 patients with intractable TLE who underwent an anterior temporal lobectomy between 1988 and 1993. The epileptogenic temporal lobe was determined by ictal LTM. A single awake-sleep outpatient EEG with standard activating procedures was performed before LTM. EEGs were analyzed by a blinded investigator.
Results: MRI scans showed unilateral medial temporal atrophy (109 patients) or symmetrical hippocampal volumes (50 patients). The surgically excised epileptogenic brain tissue revealed mesial temporal sclerosis, gliosis, or no histopathologic alteration. Routine EEG revealed temporal lobe epileptiform discharges in 123 patients. Routine EEG findings correlated with the temporal lobe of seizure origin (p < 0.0001) and the results of MRI volumetric studies (p < 0.0001). Interictal epileptiform discharges were seen only during LTM in 24 patients. Routine EEG was disconcordant with interictal LTM in another 20 patients. MRI-identifed unilateral medial temporal lobe atrophy was a strong predictor of operative success (p < 0.0001). There was no significant relation between the routine EEG findings and operative outcome (p > 0.20).
Conclusions: Results of this study modified our approach in patients with TLE. Interictal epileptiform discharges localized to one temporal lobe on serial routine EEGs or during LTM may be adequate to identify the epileptogenic zone in patients with MRI-identified unilateral medial temporal lobe atrophy.     

FDG- and Dopa-PET in postencephalitic parkinsonism

Summary. We report a case of a 74-year old woman who following an acute virus encephalitis developed an akinetic-rigid Parkinson syndrome with tremor, hypokinesia, hypomimia, rigidity and cogwheel phenomenon in all four extremities, brady-dysdiadochokinesia as well as myoclonic jerks of the arms. Many of the clinical features of this postencephalitic parkinsonism (PEP) suggested the diagnosis of sporadic encephalitis lethargica, first described by von Economo 1917. Cerebral spinal fluid showed signs of a viral encephalitis, and a positive influenza A IgA-antibody titer (1 : >160) in the viral serologic screen was found. Positron emission tomography (PET) showed an altered pattern of glucose- and dopa-metabolism clearly different from findings in idiopathic Parkinson syndrome (IPS). The acute lack of inhibitory input from the substantia nigra pars compacta to the striatum could explain the different metabolic patterns in our case in comparison to IPS patients. Our findings indicate that PEP may also be caused by influenza A and furthermore that PET clearly distinguishes PEP from IPS. Received January 27, 2000; accepted March 29, 2000     

MRI和CT阴性表现的脑致痫灶定位研究

目的回顾性分析难治性癫痫手术治疗的临床资料,探讨MRI和CT阴性表现病例的致痫灶定位方法.方法经MRI和CT检查呈阴性表现的癫痫患者42例,应用发作症状评估、长程头皮和颅内电极视频脑电图（video-EEG）监测等方法综合定位致痫灶.结果36例（85.7%）患者可以明确定位致痫灶,其中位于颞叶19例,额叶12例,额叶＋颞叶3例,顶枕叶2例;多灶性起源或定位不明确者6例,2例放弃手术.40例脑致痫灶组织均有不同程度的病理改变.结论一些局灶性皮质发育不良、微发育不良等细微脑组织改变通过现有的MRI和CT影像学检查尚难以发现,而它们常常是导致癫痫发作的病理基础.综合分析患者的临床发作特点,特别是长程EEG监测资料,可为大部分的此类病例明确定位脑致痫灶.     

300例癫痫及可疑癫痫患者AEEG分析

目的：对３００例癫痫及可疑癫痫患者的动态脑电图的应用价值进行了初步探讨。方法;使用北京明思公司ＳＷ－ＪＨ系列智能化脑电监护仪描记,并与常规脑电图比较。结果：３００例中ＥＥＧ异常５４例,ＡＥＥＧ异常１７８例ＡＥＥＧ痫样放电检出率明显高天ＥＥＧ。１４４例继发性癫痫患者中,ＥＥＧ异常８例,ＡＥＥＧ异常１０例,二者无显著性差异。     

Prospective use of subtraction ictal SPECT coregistered to MRI (SISCOM) in presurgical evaluation of epilepsy

Purpose: In patients with drug‐refractory focal epilepsy, nonlesional magnetic resonance imaging (MRI) or discordant data of presurgical standard investigations leads to failure generating a sufficient hypothesis for electrode implantation or epilepsy surgery. The seizure‐onset zone can be further investigated by subtraction ictal single‐photon emission computed tomography (SPECT) coregistered to MRI (SISCOM). This is an observational study of a large consecutive cohort of patients undergoing prospective SISCOM to generate hypothesis for electrode implantation or site of epilepsy surgery. Methods: One hundred seventy‐five consecutive patients undergoing presurgical evaluation with either nonlesional MRI or discordant data of standard investigations preventing the generation of hypothesis for seizure onset were evaluated with SISCOM. Results were compared to gold standard for seizure onset detection, either electrocorticography (ECoG) and/or postoperative outcome. Key Findings: One hundred thirty patients had successful SPECT injection. Hypothesis for electrode implantation/site of surgery was generated in 74 patients. Forty patients had gold standard comparison. Twenty‐eight patients underwent resective surgery. SISCOM was concordant to site of surgery in 82%. An additional 12 patients underwent invasive EEG monitoring but were not suitable for surgery. SISCOM was concordant multifocal in 75%. Two years postsurgical follow‐up of 26 patients showed favorable outcome in 22 (Engel class I and class II). Significance: SISCOM is a highly valuable diagnostic tool to localize the seizure‐onset zone in nonlesional and extratemporal epilepsies. Outcome in this patient group was unexpectedly good, even in patients with nonlesional MRI. The high correlation with ECoG and site of successful surgery is a strong indicator that outcome prediction in this patient group should be adapted accordingly, which may encourage more patients to undergo electrode implantation and subsequent successful surgery. Statistical analysis showed that SISCOM with shorter duration of seizures, focal seizures, and lesional MRI was more likely to generate implantation hypothesis.