癫痫性痉挛发作的头皮及颅内脑电图特点

目的：研究难治性癫痫性痉挛发作患者的头皮及颅内脑电图（EEG）特点，探讨与痉挛发作相关的EEG变化及其与发作间期放电、神经影像学之间的关系。方法：回顾性分析经外科手术治疗的11例患者的临床资料，分析头皮同步视频脑电图（V-EEG）。此11例患者均行术中皮层EEG监测30～60min，其中4例术前行颅内电极长程EEG监测。结果：8例患者表现为双侧基本对称的痉挛发作，发作期头皮EEG为全导高波幅慢波、尖波伴低波幅快波活动或广泛低波幅快波活动发放；另3例患者表现为一侧肢体的痉挛发作，EEG为局灶性棘慢波发放。术中皮层监测5例患者为反复的、暴发出现的多棘波活动，2例患者见持续性的棘波、尖波活动，4例未见明显的癫痫样电活动。4例行颅内电极监测者发作期EEG表现，2例为“前导性”的高波幅棘波伴随20Hz左右的低波幅快波发放；另2例为局灶性低波幅快波活动并迅速扩散，无“前导性棘波”。手术切除“前导性棘波”或反复性、节律性痫样放电的皮层可消除发作。结论：在一部分癫痫性痉挛发作患者，其痉挛发作可能因新皮层局灶的电发放点燃，颅内EEG如果存在前导性的棘波，这个棘波部位可能是促发痉挛发作的点燃灶。完整切除术中监测呈现反复性、节律性痫样放电的皮层可取得较好的手术效果。

Epileptic Spasms:scalp EEG and intracranial EEG analysis

Objective：To analyze the changes of scalp and intracranial EEG at ictal in patients with medically refractory epileptic spasms and to assess the changes of ictal discharges associated with spasms and their relation to interictal epileptiform activity and neuroimaging. Methods： Eighty-two seizures from 11 patients, aged 1 - 19 years were analyzed with intraoperative electrocorticography （EcoG）. Ictal events were also analyzed with intracranial EEG from 4 patients, who were being performed for cortical resection. Results： Patients with EcoG monitoring, apart from diffuse sporadic spikes, displayed with continuous or frequent rhythmic epileptogenic discharges （CED） recorded from cortex with MRI lesion. For patients with chronic intracranial EEG monitoring, the spasms were associated with either a ＂leading＂ spike followed by fast-wave bursts or fast-wave bursts without a ＂leading＂ spike. Resection of the associated cortex achieved good surgical outcome. Fast-wave bursts were associated with spasms. Con- clusion： Epileptic spasms may be triggered by a focal neocortical impulse in a subset of patients, and a leading spike might be used as a marker of the trigger zone for epileptic spasms. Rapidly emerging widespread fast-wave bursts might explain the clinical semiology of epileptic spasms. Completeness of excision of cortical tissue displaying CED is possitively corrlated with surgical outcome.