几种以皮层病灶起源的失神样癫痫发作患者的临床与脑电特征

目的：探讨几种由皮层病灶起源的失神样癫痫的发作分类,并就其临床与脑电特征进行分析讨论,为临床诊断失神样癫痫发作提供有价值的材料.方法：回顾性分析了我所近1年多来进行术前V-EEG监测到皮层病灶起源的24例具有明显失神样癫痫发作患者的临床、EEG及影像学资料.结果：24例中17例患者经头皮与颅内电极皮层和（或）深部电极]描记EEG并进行了手术.失神发作时以额叶皮层起源放电者5例,颞叶7例,顶-枕叶5例 其余7例中4例属Lennox-Gastaut综合征,另3例因皮层多发病灶未进行手术.不同脑皮层部位起源的放电均可引起失神样发作,但其临床与脑电有各自的特点.脑电图出现3 Hz棘慢综合波时并非全是典型的失神样发作.结论： 失神样癫痫发作可分为全面性与部分性两大类,诊断失神样癫痫发作时应将EEG与临床资料进行综合分析,以免误诊.

The clinical and EEG features of various types of absence epilepsy seizures caused by cortical nidus

Objective： 1） To investigate the classification of absence epilepsy seizures caused by the cortical nidus; 2）To analyse their clinical and electroencephalogram （EEG） features; 3）To provide reliable criterion of clinical diagnosis for absence epilepsy seizures. Methods： By reviewing and analysing the V-EEG of the patients with cortical nidus during the last year in the institute, 24 cases were found appearing undoubtable absence epilepsy features in the clinical, EEG and image data. Results： Operations were performed in 17 patients who were scanned by epicranium and intracranial（cortical and/or depth） electrodes. Five cases discharged originating from the frontal lobe during absence epilepsy attack, 7 from the temporal lobe, and 5 from the parietal-occipital lobe. Of other 7 patients without operation,4 suffered from Lennox-Gastaut syndrome and 3 had multiple nidus in cortex. The absence epilepsy seizures were triggered by the discharge located in different parts of cortex; however, their clinical and EEG features were different from each other. Not all the polyspike and slow wave complex with 3 Hz frequency EEG were typical absence epilepsy seizures. Conclusion： The absence epilepsy could be classified into both the generalized and partial seizures. In order to avoid misdiagnosis, it is necessary to analyze EEG and clinical data.