脑卒中后继发性癫(癎)56例临床分析

目的:探讨脑卒中伴继发性癫(癎)患者的临床特点.方法:对收治的56例脑卒中伴继发型癫(癎)患者临床资料进行分析,探讨癫(癎)发作与脑卒中发作类型、脑卒中发作部位、脑卒中发作时间的关系.结果:脑卒中伴继发性癫(癎)患者中出血性卒中41例,占73％;脑卒中后癫(癎)的发生与皮层损害密切相关,56例中大脑皮层损害的患者占54例,占96％;在脑卒中患者中早发型癫(癎)38例(68％),晚发型癫(癎)18例(32％);早发型癫(癎)以出血性卒中为主,占74％;晚发型癫(癎)以缺血性卒中为主,占67％.结论:脑卒中后癫(癎)的发生与卒中的位置及卒中的类型密切相关,应早期做好预防工作和采取干预措施.     

急性脑血管病继发癫(癎)的临床分析

目的:探讨急性脑血管病继发癫(癎)的临床特点、发病机制、发作类型及治疗预后.方法:对我科2006年1月～2014年1月收治的经头颅CT、MRI证实的389例急性脑血管病继发癫(癎)患者的临床资料进行分析,总结其临床特点、发病机制、发作类型、治疗及预后.结果:本组急性脑血管病继发癫(癎)的发病率为4.77％(389/8 152),癫(癎)发病率与脑血管病的类型、发病部位有关;其中以脑梗死患者、累及皮层或邻近皮层者易患,发作形式以单纯部分性运动发作的发病率较高.结论:急性脑血管病继发癫(癎)的原因主要与脑水肿有关,病灶主要位于皮层或邻近皮层者易发作,发作类型以单纯部分性运动为多,累及大脑皮层者发生癫(癎)的危险性高,预后较差.     

脑卒中后癫(癎)68例视频脑电图监测分析

目的:探讨卒中后癫(癎)(PSE)患者视频脑电图(V-EEG)监测结果与临床资料的对应关系.方法:回顾性分析68例脑卒中后癫(癎)患者的神经影像学资料、临床发作症状和V-EEG改变特点,同时分析异常放电部位与卒中病变部位、类型以及发作类型的对应关系.结果:V-EEG对卒中后癫(癎)阳性检出率为85.3%,与常规脑电图检出率的30.9%比较,差异有显著意义(P<0.01);PSE发生与卒中病变部位有明显相关性,脑叶出血或脑梗死累及大脑皮层区的发生率较其他部位的病变明显增高;V-EEG的异常放电部位、程度与卒中病变部位和范围以及发作类型有高度关联性.结论:V-EEG能显著提高PSE阳性检出率,(癎)样放电与卒中病变部位和性质密切相关,并有助于明确其癫(癎)发作类型,指导临床选药.     

脑梗死后迟发性癫癎96例临床分析

脑卒中是成年人癫癎的常见原因，卒中后2周内发生者为早发性癫癎，2周后发生者为迟发性癫癎。各型脑卒中癫癎发生率不同。出血性脑卒中癫癎发生率略高于缺血性中风，而缺血性中风中的脑栓塞患者癫癎发生率较高。现将1999年7月至2004年1月就诊于我科的脑梗死后迟发性癫癎患者96例进行临床分析如下。     

动态脑电图对缺血性脑卒中后继发癫癎的研究

目的:探讨缺血性脑卒中后继发性癫癎动态脑电图(AEEG)变化、神经功能的缺损情况及临床疗效与预后。方法:将40例缺血性脑卒中后后继发性癫癎患者设为研究组,回顾其AEEG资料,常规脑电图与动态脑电图检查比较;并与对照组40例缺血性脑卒中后无癫癎发作患者进行比较分析。结果:常规脑电图与动态脑电图检查比较:常规脑电图(REEG)检查中度和重度异常16例,占40%;AEEG检查中度和重度异常的比率为35例,占87.5%,AEEG较REEG检查的中、重度异常比率明显增高,具有统计学差异。研究组患者AEEG异常率占95.0%;发生在脑叶皮质区的患者继发癫癎的概率高于发生在皮质下区的患者,两者间AEEG比较差异有统计学意义(P0.05)。结论:AEEG可显著提高卒中后癫癎发作患者的脑电异常检出率,其检查结果对预测癫癎发作、病情变化、预后有着重要的价值。     

卒中后癫痫临床分析

目的 探讨脑卒中后癫痫的临床特点及发病机制.方法 对1140例脑卒中病例中93例继发癫痫的临床资料进行回顾性分析.结果 脑卒中癫痫的总发生率8.16%,卒中后早期癫痫的发生率为54.84%(51/93),晚期发生率为45.16%(42/93).卒中后癫痫的发生率与病灶部位(皮质/皮质下)差异有显著性(P<0.05).结论 脑卒中是老年人癫痫发作的常见原因,皮层病灶较易发生癫痫.     

高龄癫(癎)的低电压脑电图与CT的对比分析

目的:探讨低电压脑电图与老年人癫(癎)发病的相关性.方法:对22例62～79岁的老年晚发癫(癎)患者的脑电图与CT进行对比分析,并将18～55岁,脑电图为低电压的人群做为对照组进行分析.结果:入选组,22例患者的低电压脑波,14例CT显示阳性,其中,9例为脑梗塞,4例为脑动脉硬化伴脑萎缩,1例为脑软化灶.而对照组中44例,仅有1例CT显示脑梗塞,1例钙化点,两组比较X2=27.9134,P＜0.01.结论:在老年人中,癫(癎)发作患者表现为低电压脑波时,应警惕脑器质性病变的存在,要及时做CT检查.     

癫(癎)外科中长程视频脑电图监测的应用

目的:探讨长程视频脑电图(VEEG)监测对癫(癎)发作的起源和定位的作用和意义.方法:120例患者均行长程视频脑电图检查,其中73佣监测中可见明确的局灶性(癎)样放电,结合临床发作形式和发作期脑电图以及影像学检查,73例为症状性癫(癎),且均有手术治疗的意愿,经准确定位癫(癎)灶后,实施手术治疗,手术中均行皮层脑电图监测(CoEEG).23例脑电检测中发现明显(癎)样放电,因放电灶分散或位于功能区或因脑肿瘤伴发癫(癎)或患者发作不太频繁且不愿意接受开颅手术者,行伽玛刀治疗.结果:73例开颅手术者,术中均监测到皮层棘波放电.术后随访6～24个月,发作停止者70例,明显减少者2例,无显著改善者1例,有效率99%.结论:长程视频脑电监测在癫(癎)术前评估定位致(癎)灶方面具有重要意义.     

头皮脑电图继发双侧同步样放电的特点及其临床意义

目的:探讨局灶性癫(癎)患者头皮脑电图(EEG)上继发双侧同步(癎)样放电(SBSD)的表现特点及临床意义.方法:回顾性地分析自2002年3月至2006年3月,于我研究所接受治疗的所有局灶性癫(癎)患者的EEG资料,排除所有颞叶癫(癎),共32例患者的术前EEG上均存在SBSD表现.对这些患者的发作间期与发作期EEG结果进行分析研究.结果:32例患者中,SBSD起源于额区者20例,枕区者10例,顶区者2例.SBSD可表现为棘或尖波、棘慢复合波与快节律三种类型,以棘慢复合波最为常见,占63%.SBSD发作间期较为常见的特点是双侧存在时间差,SBSD始于EEG局灶性异常改变以及局限性慢波一侧;53%的病人发作期EEG表现为局灶性起源.结论:SBSD在局灶性癫(癎)患者中并不少见,而且以额叶最为常见.通过分析SBSD波形的各个特点,有助于判断SBSD原发灶侧别,并与全面性癫(癎)相鉴别,对癫(癎)外科的术前评估具有非常重要的临床意义.     

头皮脑电图继发双侧同步(癎)样放电的特点及其临床意义

目的:探讨局灶性癫(癎)患者头皮脑电图(EEG)上继发双侧同步(癎)样放电(SBSD)的表现特点及临床意义.方法:回顾性地分析自2002年3月至2006年3月,于我研究所接受治疗的所有局灶性癫(癎)患者的EEG资料,排除所有颞叶癫(癎),共32例患者的术前EEG上均存在SBSD表现.对这些患者的发作间期与发作期EEG结果进行分析研究.结果:32例患者中,SBSD起源于额区者20例,枕区者10例,顶区者2例.SBSD可表现为棘或尖波、棘慢复合波与快节律三种类型,以棘慢复合波最为常见,占63%.SBSD发作间期较为常见的特点是双侧存在时间差,SBSD始于EEG局灶性异常改变以及局限性慢波一侧;53%的病人发作期EEG表现为局灶性起源.结论:SBSD在局灶性癫(癎)患者中并不少见,而且以额叶最为常见.通过分析SBSD波形的各个特点,有助于判断SBSD原发灶侧别,并与全面性癫(癎)相鉴别,对癫(癎)外科的术前评估具有非常重要的临床意义.     

脑卒中后癫痫60例临床分析

目的探讨脑卒中癫痫的，I岳床特点及发病机制。方法对1000例脑卒中患者中60例继发性癫痫患者的临床资料进行回顾性分析。结果脑卒中癫痫的总发生率6．00％，卒中后早期癫痫的发生率为53．33％（32／60），晚期发生率为46．67％（28／60），以部分发作为最多占65．00％（39／60），卒中后癫痫的发生率与病灶部位有关，皮质病灶较易发生卒中后癫痫，皮质（10．65％）与皮层下（2．73％）比较差异有显著意义（P〈0．05），而不同卒中类型癫痫发生率差异无显著意义（P〉0．05）。结论脑卒中是老年人癫痫发作的最常见原因，皮层病灶较易发生癫痫。     

脑出血后并发癫痫的前瞻性研究

目的:为探讨脑出血与癫痫发作之间的关系。方法:对202例脑出血病例进行前瞻性癫痫发作研究,并设对照组进行对照分析。结果:脑出血后并发癫痫发病率18.8％,(其中早发性癫痫73.7％,晚发性癫痫26.3％),病灶累及皮层并发癫痫发生率22/81,累及皮层下并发癫痫发生率16/121,是脑出血后癫痫死亡率26.3％。结论:脑出血后并发癫痫是脑出血病情凶险的表现(18.8％),皮层病灶继发癫痫发生率高,但出血后并发癫痫发作的预后较好。     

The effect of initial serum neuron-specific enolase level on clinical outcome in acute carotid artery territory infarction

The prediction of functional outcome in patients with acute cerebral infarction depends on many factors. Various techniques have been applied to predict severity and outcome after cerebral infarction. Neuron-specific enolase (NSE) is a component of a specific brain enzyme and a useful marker of brain injury. We evaluated the relation between initial serum NSE level and short- and long-term clinical outcome in 59 patients with acute cerebral infarction and in 38 age-matched healthy controls. Serum NSE levels were determined in patients with carotid artery (CA) territory cerebral infarction within 24 hours of onset. Brain MRI was performed four to seven days after stroke. Patients were divided into two groups: large CA territory infarction with a lesion extending cortex (cortex group), and small subcortical CA territory infarction (subcortical group) with a lesion confined to the subcortical white matter. We compared the initial serum NSE levels of the two groups. National Institute of Health Stroke Scale (NIHSS) was determined at admission and seven days after onset and the modified Rankin's scale was used at the 3 months follow-up after onset. Serum NSE levels were significantly elevated in patients with acute cerebral infarction compared with the normal controls (13.88 +/- 5.47 ng/dl vs. 8.15 +/- 1.53 ng/dl, p < 0.05). The initial (< 24 h) serum NSE level was higher in the cortical group than in the subcortical group (16.68 +/- 5.70 ng/dl vs. 10.98 +/- 3.34 ng/dl, p < 0.05). NIHSS on admission and on the 7th day correlated with the initial serum NSE level (p < 0.05), as were more severe functional outcomes, as determined 3 months after onset (p < 0.05). This study shows that initial serum NSE level may be a useful marker for severity in acute ischemic stroke, and that it may be well correlated with short-term and long-term functional outcomes.     

影像学正常的癫痫患者的SPECT与长程EEG研究

目的：探讨影像学（CT和MRI）正常的癫痫病例的发作间期SPECT与脑电图（EEG）特点。方法：对100例影像学正常病例在发作间期进行SPECT显像、EEG长程监测。结果：共100例中,男57例,女43例。年龄1～54岁。病程平均3．77年。可追溯到病因者63％。全身性发作58％（全身强直阵挛发作52％）,局灶性发作42％。发作间期SPECT异常100％,其中低灌注67％,高灌注30％,高一低灌注3％。异常灌注灶156个：脑区151个（97％）,其中颞叶76例94个（60％）。长程EEG监测正常17％,异常83％,异常者中90％有痫样放电。局灶性异常45％和弥漫性异常54％,EEG正常的全身性发作与局灶性发作差异明显（P〈0．01）;局灶性异常中全身性发作与局灶性发作比较差异有统计学意义（P〈0．05）。结论：影像学正常而发作间期SPECT异常的癫痫病例和EEG异常明显增高,全身性发作者各脑区均存在异常灌注灶,其中颞叶异常灌注灶占60．2％。     

神经影像学与长程VEEG 对脑结构异常所致症状性癫癎的应用价值

目的：探讨视频脑电图与神经影像学检查在脑结构异常所致症状性癫癎中的应用价值。方法：回顾分析经临床诊断明确的脑结构异常所致症状性癫癎45例患者,探讨其神经影像学及脑电图的特点,并分析其相关性。结果：45例患者中胶质瘤12例,以星型胶质细胞瘤为主,脑膜瘤2例,动静脉畸形（AVM）4例,蛛网膜囊肿6例,脑囊虫3例,脑软化7例,海马硬化4例,脑脓肿3例,钙化4例。以上病例均经手术病检证实。VEEG有癎样放电者38例,非特异性异常3例,脑电图正常者4例。34例（75.6%）患者病理灶与致癎灶一致,病理灶与致癎灶相反者2例（4.4%）,另有2例（4.4%）双侧致癎灶的患者神经影像学却为单侧病灶。结论：在症状性癫癎患者致癎灶的定位中VEEG可使大部分患者获得致癎灶的定位信息;神经影像学对症状性癫癎的病理灶定位有重要意义;VEEG和神经影像学检查相结合可提高癫癎患者致癎灶定位的准确性。     

Evolution of hippocampal epileptic activity during the development of hippocampal sclerosis in a mouse model of temporal lobe epilepsy

Unilateral intrahippocampal injection of kainic acid in adult mice reproduces most of the morphological characteristics of hippocampal sclerosis (neuronal loss, gliosis, reorganization of neurotransmitter receptors, mossy fiber sprouting, granule cell dispersion) observed in patients with temporal lobe epilepsy. Whereas some neuronal loss is observed immediately after the initial status epilepticus induced by kainate treatment, most reorganization processes develop progressively over a period of several weeks. The aim of this study was to characterize the evolution of seizure activity in this model and to assess its pharmacological reactivity to classical antiepileptic drugs.Intrahippocampal electroencephalographic recordings showed three distinct phases of paroxystic activity following unilateral injection of kainic acid (1 nmol in 50 nl) into the dorsal hippocampus of adult mice: (i) a non-convulsive status epilepticus, (ii) a latent phase lasting approximately 2 weeks, during which no organized activity was recorded, and (iii) a phase of chronic seizure activity with recurrent hippocampal paroxysmal discharges characterized by high amplitude sharp wave onset. These recurrent seizures were first seen about 2 weeks post-injection. They were limited to the injected area and were not observed in the cerebral cortex, contralateral hippocampus or ipsilateral amygdala. Secondary propagation to the contralateral hippocampus and to the cerebral cortex was rare. In addition hippocampal paroxysmal discharges were not responsive to acute carbamazepine, phenytoin, or valproate treatment, but could be suppressed by diazepam.Our data further validate intrahippocampal injection of kainate in mice as a model of temporal lobe epilepsy and suggest that synaptic reorganization in the lesioned hippocampus is necessary for the development of organized recurrent seizures.     

脑卒中后癫痫71例临床分析

目的 探讨脑卒中后癫痫的临床特点及预后。方法 回顾性分析脑卒中后继发癫痫71例的临床资料。结果 脑卒中后癫痫的发生率为5．37％，其中发生于蛛网膜下腔出血30．23％，脑出血6．05％，脑梗死4．04％。本组早发性癫痫37例，28例为强直一阵挛性发作，迟发性癫痫34例，24例为部分性发作。结论 脑卒中后癫痫发生率以蛛网膜下腔出血最高。早期多为强直一阵挛性发作，晚期主要是部分性发作，对脑卒中后癫痫发作必须依据不同情况进行治疗。     

动态脑电图对缺血性脑卒中后继发癫痫的研究

目的：探讨缺血性脑卒中后继发性癫癎动态脑电图（AEEG）变化、神经功能的缺损情况及临床疗效与预后.方法：将40例缺血性脑卒中后后继发性癫癎患者设为研究组,回顾其AEEG资料,常规脑电图与动态脑电图检查比较;并与对照组40例缺血性脑卒中后无癫癎发作患者进行比较分析.结果：常规脑电图与动态脑电图检查比较：常规脑电图（REEG）检查中度和重度异常16例,占40％;AEEG检查中度和重度异常的比率为35例,占87.5％,AEEG较REEG检查的中、重度异常比率明显增高,具有统计学差异.研究组患者AEEG异常率占95.0％;发生在脑叶皮质区的患者继发癫癎的概率高于发生在皮质下区的患者,两者间AEEG比较差异有统计学意义（P＜0.05）.结论：AEEG可显著提高卒中后癫癎发作患者的脑电异常检出率,其检查结果对预测癫癎发作、病情变化、预后有着重要的价值.     

Inpatient Stroke Rehabilitation Outcomes in Korea Derived from the Korean Brain Rehabilitation Centers' Online Database System for the Years 2007 to 2011

The purpose of this report was to provide information for patients receiving inpatient rehabilitation after stroke and to identify the possible factors influencing functional outcome after inpatient rehabilitation. Stroke patients (n = 5,212) who were discharged from the Departments of Rehabilitation Medicine (RM) of university hospitals and rehabilitation hospitals from 2007 through 2011 were participants. Prevalence, age, transfer time after onset, length of stay (LOS), functional status at admission and discharge were analyzed. In all stroke subjects, cerebral infarctions (67%) were more common than hemorrhages. Cerebral infarctions in the middle cerebral artery territory were most common, while the basal ganglia and cerebral cortex were the most common areas for hemorrhagic stroke. The LOS decreased from 45 to 28 days. Transfer time after onset decreased from 44 to 30 days. Shorter transfer time after onset was correlated with better discharge functional status and shorter LOS. Initial functional status was correlated with discharge functional status. In ischemic stroke subtypes, cerebellar and brainstem strokes predicted better outcomes, while strokes with more than one territory predicted poorer outcomes with more disabilities. In hemorrhagic stroke subtypes, initial and discharge functional status was the lowest for cortical hemorrhages and highest for brainstem hemorrhages. This report shows that LOS and transfer time after onset has been decreased over time and initial functional status and shorter transfer after onset are predictors of better functional outcome at discharge.     

颅脑术后继发癫的脑电图表现

&&颅脑术后继发癫的脑电图表现@齐伟 @吴厚慧&&