动态脑电活动监测对儿童发作性脑疾病的评估

背景:24 h动态脑电图是在常规脑电图基础上延长描记时间,以便对各个状态下的脑电活动进行监测,从而大大提高了癫痫患儿的检出率.目的:通过对癫痫和可疑癫痫患者进行24 h动态脑电图监测,探讨其对儿童发作性脑疾病的评估价值.设计:病例分析.单位:江西医学院第二附属医院神经内科.对象:选择2001-07/2004-10江西医学院第二附属医院神经内科住院及门诊的发作性脑疾病患儿151例,其中男99例,女52例,年龄3个月～14岁.根据临床诊断分为两组:癫痫组85例,可疑癫痫组66例.151例患儿中有39例曾行脑电图检查,21例行CT检查,3例行MRI检查.方法:对参加者详细询问病史、神经科查体,进行24 h动态脑电图监测(凡在监测期间出现棘波、尖波、棘(尖)慢综合波、爆发性高幅慢波、高度失律波、新生儿单一节律爆发波者,以及过度换气早期突破或局限性爆发性慢波者均为痫样放电;背景波异常,儿童期枕部阵发性慢波,睡眠期极度纺缍波及新生儿散发性一过性尖波,偶见不典型尖-慢波综合均属非特异性异常),并收集常规脑电图、CT或MRI检查结果.主要观察指标:①观察24 h动态脑电图对儿童发作性疾病的异常率、痫样放电率.②痫样放电时间、部位、临床发作与异常发作的关系.③将24 h动态脑电图对儿童发作性疾病的异常率、痫样放电率与常规脑电图、CT或MRI结果进行对比分析.结果:151例患儿均进入结果分析.①151例患儿动态脑电图监测结果异常122例,其中痫样放电97例.癫痫组痫样放电率明显高于可疑癫痫组79%(67/85),45%(30/66),(x2=18.008,P＜0.005)].②癫痫组中动态脑电图痫性放电以一侧半球或局限性一侧偏胜以及双侧大脑半球为主,可疑癫痫组中以双侧大脑半球痫样放电出现率最高.③痫样放电时间以睡眠时期为主,占74%(72/97),其中68%(44/97)见于浅睡期.④癫痫组临床发作14例,痫样放电出现率93%(13/14),明显高于可疑癫痫组临床发作25例,痫样放电出现率12%(12/25),(x2=6.741,P＜0.01)].⑤151例患儿中有39例曾行常规脑电图检查,其中非特异性异常19例,痫样放电7例;动态脑电图中非特异性异常5例,痫样放电29例,两组患儿的常规脑电图以非特异性异常为主,动态脑电图以痫样放电为主.结论:24 h动态脑电图用于诊断儿童发作性脑疾病的痫样放电率明显增高,并能确定放电部位及时间,充分体现了动态脑电图对儿童发作性脑疾病评估的优越性.

Dynamic electroencephalogram monitoring in evaluation of paroxysmal cerebral disorder in children

BACKGROUND: Twenty-four hours dynamic electroencephalogram (EEG)is to prolong the time of scanning on the basis of routine EEG to monitor electrical activity of brain in various states, by which, the detectable rate of epilepsy is much improved in children.OBJECTIVE: To probe into the evaluation of 24 hours dynamic EEG monitoring on paroxysmal cerebral disorder in children in epileptic and suspected epileptic patients.DESIGN: Case analysis.SETTING: Department of Neurological Internal Medicine of Second Affiliated Hospital of Jiangxi Medical College.PARTICIPANTS: Totally 151 cases of paroxysmal cerebral disorder were employed, diagnosed in clinic and from the inpatients in Department of Neurological Internal Medicine of Second Affiliated Hospital of Jiangxi Medical College from July 2001 to October 2004, of which, 99 cases were male, 52 cases female, aged varied from 3 month to 14 years. According to clinical diagnosis, two groups were divided, named epileptic group (85 cases) and suspeeted epileptic group (66 cases). Of 151 eases, 39 cases received EEG examination, 21 cases CT scanning examination and 3 cases MRI examination.METHODS: All of participants were inquired medical history in detail,received physical examination in Neurological Department and 24 hours dynamic EEG monitoring those were determined as epileptic discharge if during the monitoring, it was present spike wave, sharp wave, spike and ware complex, burst high-amplitude slow wave, high-arrhythmic wave,neonatal single rhythmic burst wave and hyperventilation early breakthrough or limitative burst slow wave. Those were determined as non-specific abnormality if it was present abnormal background wave, occipital paroxysmal slow wave of childhood, extreme spindle wave of sleep stage,neonatal diffusive transient sharp wave and occasional non-classic sharpslow complex.]. In addition, the results of routine EEG, CT or MRI examinations were collected.epileptiform discharge of paroxysmal disorder in children during 24 hours of abnormal rate and epileptiform discharge of paroxysmal disorder in children during 24 hours dynamic EEG monitoring with the results of routine EEG, CT or MRI examinations.dynamic EEG monitoring, of 151 cases, abnormality was present in 122cases, of which, 97 cases had epileptiform discharge. The epileptiform discharge rate in epileptic group was higher remarkably in suspected epileptic tic group, epileptiform discharge in dynamic EEG was mainly in unilateral hemisphere or dominant in limitative unilateral side and bilateral cerebral hemisphere. In suspected epileptic group, the detectable rate of epileptiEpileptiform discharge was predominated in sleep period (74%, 72/92), of peared clinic seizure in epileptic group, of which, the detectable rate epileptiform discharge was 93% (13/14), higher remarkably than suspected epileptic group 25 cases of clinic seizure, epileptiform discharge decases received routine EEG examination, of which, 19 cases were present non-specific abnormality and 7 cases had epileptiform discharge; in dynamic EEG examination, 5 cases were present non-specific abnormality and 29 cases had epileptiform discharge. In comparison, non-specific abnormality was dominant in routine EEG and epileptiform discharge was predominated in dynamic EEG.CONCLUSION: Twenty-four hours dynamic EEG examination results in remarkable high detectable rate of epileptiform discharge in diagnosis of paroxysmal disorder in children and determines discharge location and time, indicating fully the advantage of dynamic EEG in evaluation of paroxysmal cerebral disorder in children.