头皮脑电图发作间期持续周期性局限性低波幅棘波的皮质脑电图特点及其对致痫灶的定位意义

目的 通过分析头皮脑电图上周期性局限性低波幅棘波的皮质脑电图特点,揭示皮质电场被头皮脑电图记录到的影响因素及此种低波幅棘波对致痫灶的定位意义.方法 以5例头皮脑电图上发作间期表现为周期性局限性低波幅棘波持续性发放为特点的难治性癫痫患者为研究对象.应用DaVinci系统所提供的数据分析功能对头皮脑电图和皮质脑电图上所记录的发作间期的棘波进行分析,测量棘波的波幅及棘波灶的范围;应用Matlab和Spike2软件的功率谱密度、自相关图和相干性分析等功能分析棘波灶的周期性震荡活动和同步性电活动;应用t检验进行统计学分析.结果 5例患者在头皮脑电图所记录的棘波的波幅(μV)分别为:22.2±4.8、30.4±7.1、20.7±3.2、58.4±10.1、23.4±3.9;在皮质脑电图所记录的棘波的波幅(μV)分别为:1253.8±199.3、806.5±161.4、1585.7±305.7、922.5 ±140.6、736.8 ±70.9.t检验显示皮质脑电图的棘波波幅显著高于头皮脑电图所记录到的棘波波幅(t=6.394,P＜0.05).5例患者棘波灶在大脑皮质上的面积(cm2)分别为:4.0、6.0、3.5、5.5、6.5.功率谱密度和自相关图分析表明这些棘波灶存在1～3 Hz的周期性震荡活动.互相关图和相干性分析表明皮质脑电图棘波灶内各电极触点的电活动具有同步性.结论 头皮脑电图发作间期持续周期性局限性低波幅棘波,对癫痫患者的术前定位具有一定的参考价值.     

伴强直性发作癫痫患儿的临床表现和脑电图特征

目的通过对67例伴强直性发作癫痫患儿的临床表现及视频脑电图(VEEG)特点分析,提高对该发作类型的诊断水平。结果收集河北省儿童医院神经内科67例伴强直性发作的癫痫患儿的病例资料,分析其临床表现和VEEG特征。结果 67例患儿均监测到明确的临床发作,其中清醒期发作19例(28%),睡眠期发作30例(45%),且容易出现在睡眠I期、II期。发作间期脑电图表现:①背景活动正常37例,慢化者15例;②广泛性棘波节律阵发,易出现在非快速眼动期(NREM期);③广泛性及多灶性慢波、棘慢波或多棘慢波阵发;④一侧或双侧前头部棘波、棘慢波或θ活动发放;⑤单侧或双侧Rolandic区棘慢波发放;⑥高度失律。发作期脑电图表现:①局灶起始的棘波节律发放;②广泛性棘波节律发放;③广泛性慢波阵发,其上复合或其后跟随棘波节律;④广泛性4~6Hz棘慢波发放→广泛性棘波节律阵发;⑤广泛性低波幅棘波节律发放→广泛性高波幅棘慢波阵发。以上表现形式有时会组合出现于同一例患者中。发作持续时间与背景活动的关系:发作持续约1~8s者39例(39/67,58.2%),背景活动慢化者4例(4/39,10.3%);发作持续8~15s,甚者更长者(15s)28例(28/67,41.7%),背景活动慢化者11例(11/28,39.3%)。67例患者随访研究1年,最终诊断为:8例(11.9%)诊断为婴儿痉挛征,7例(10.4%)诊断为Lennox-Gastaut综合征(LGS),3例(4.4%)诊断为额叶癫痫,15例(22.3%)诊断为伴有中央颞区棘波的儿童良性癫痫(BECT),34例(50.7%)仅停留在发作类型的诊断层面。结论强直性发作可单独出现,也可出现在多种癫痫综合征中;VEEG可监测患儿发作期临床表现及脑电图异常波形,为临床诊断及鉴别诊断提供理论依据。     

脑电地形图选段编辑对阵发癲癇波的定位作用

目的探讨脑电地形图(BEAM)选段编辑功能对阵发性棘波、尖波、棘(尖)慢综合波(称癲样放电波)的定位作用.方法将42例癫癇患儿脑电图(EEG)记录到的阵发性癇样放电波进行BEAM定量分析,以棘(尖)慢综合波的慢波高功率定位.结果 EEG癲样放电波定位于双侧额区14%、单侧颞中央区45%、颞区24%、中央区17%.BEAM选段编辑,癲样放电波定位于单侧额区14%、颞区50%、中央区36%.结论 BEAM选段编辑局部定位灵敏度比EEG高60%(P《0.01),是对癇样放电波有一定定位作用的监测手段.     

儿童发作性运动诱发性运动障碍视频脑电图特征

目的总结儿童发作性运动诱发性运动障碍的视频脑电图特点及其临床意义。方法回顾分析9例发作性运动诱发性运动障碍患儿的视频脑电图资料。结果 9例患儿中男性8例、女性1例,年龄6.25~15.17岁、平均(7.10±3.24)岁,病程1~12个月、平均(6.12±2.58)个月。9例患儿共监测到45次临床发作,发作持续时间5~35 s、平均(9.21±4.35)s,临床表现为舞蹈样动作并手足徐动10次、肌张力障碍并站立不稳6次、舞蹈样动作并手足徐动和肌张力障碍并站立不稳29次;均由突发性运动诱发,其中2例(2/9)亦由过度换气诱发、1例(1/9)由惊吓刺激诱发;4例(4/9)发作前存在肢体僵硬、肢体麻木或其他感觉异常等先兆。9例患儿发作期呈现正常背景节律或被大量运动伪差覆盖,未见样放电、背景节律改变或局限性慢波节律等异常征象;发作间期背景活动正常,2例(2/9)呈非特异性异常,表现为额区或枕区间断性慢活动,1例(1/9)可见中央-颞区(Rolandic区)棘波。5例患儿(5/9)富脯氨酸跨膜蛋白2(PRRT2)基因突变阳性。结论儿童发作性运动诱发性运动障碍发作间期视频脑电图可见非特异性异常和样放电,发作期临床表现和同步脑电图对明确诊断意义重大。     

头痛间隙期伴癎性放电15例患儿的脑电图分析

目的:分析以"发作性头痛"为主诉的患儿其脑电图癎性放电部位的分布特点。方法:收集中国医科大学附属第一医院儿科门诊101例以"发作性头痛"为主诉的患儿,行脑电图检查。其中15例患儿脑电图中显示癎性放电,对癎性放电的出现部位进行分析。结果:15例患儿中有12例患儿脑电图中的癎性放电表现为散在性棘慢波,且颞叶出现率最高,为65.5%;2例患儿脑电图中的癎性放电表现为全部导联周期性及阵发性棘慢波;1例患儿脑电图中的癎性放电表现为双侧顶枕导联阵发性棘慢波。结论:头痛患者行脑电图检查十分必要,儿童患者的头痛症状应引起临床医生的重视。     

额叶癫痫的临床特点及脑电图分析

目的探讨额叶癫痫的临床特点及脑电图改变。方法抽取2011-06—2013-06在我院就诊的60例额叶癫痫患者为研究对象,分析患者的临床特点及脑电图改变情况。结果临床发作次数共148次,每例患者平均发作2.5次,其中100次为睡眠期间发作,48次为清醒期间发作;发作主要表现为全身强直阵挛、发声发作及偏转性强直等。额叶癫痫脑电图主要特点为放电部位以额区为主49例(81.67%),主要发作频率为偶发/阵法54例(90.00%),常见的节律为阵发性棘(尖)波或棘(尖)慢波38例(63.33%)。结论对于额叶癫痫,主要的临床特点为全身强直阵挛、发声发作及偏转性强直,且在夜间发作较为常见,脑电图的主要形式为额区偶发/阵发性棘(尖)波或棘(尖)慢波。     

额叶癫痫脑电模式分析

目的 探讨额叶癫痫的脑电模式特点。方法 回顾性分析2016年1月至2018年4月手术治疗的额叶有确切结构病灶或立体定向脑电图（SEEG）证实额叶起源的51例癫痫的临床资料，51例均行头皮视频脑电图（VEEG）监测，21例行SEEG监测。结果 ①VEEG表现:背景正常29例（56.86%），异常22例（43.14%）；间歇期84.31%（43/51）以棘波/棘-慢波、尖波/尖-慢波、慢波、多棘-慢波形式放电，68.63%（35/51）主要位于单侧额区、双侧额叶或与周边脑区同步放电；发作期68.63%（35/51）以快节律、棘节律、尖样节律起始放电，86.27%（44/51）位于单侧额区、双侧额叶及周边脑叶或同步。②SEEG表现:间歇期21例均有异常放电，80.95%（17/21）以棘波/棘-慢波、多棘-慢波/慢棘-慢波形式放电，部位较VEEG广泛，仍以额叶为优势，但常累及相邻深部脑区；发作期76.19%（16/21）以快活动/高频振荡（HFO）起始，均位于额叶，85.71%（18/21）来自额叶底面、深部或内侧面。结论 额叶癫痫病人VEEG表现为背景多数正常，间歇期放电以棘、尖波/棘、尖-慢波形式发放明显，常累及对侧额叶或周边脑区；SEEG较VEEG放电更频繁且广泛，发放频率更快，含棘波甚至HFO成分更高，并易累及相邻脑深部区域。     

脑卒中合并抑郁患者的脑电图特点及可能的影响因素

目的研究脑卒中合并抑郁患者的脑电图特点及可能的影响因素。方法选取2019年10月～2020年10月我院收治的72例脑卒中患者为研究对象。患者均行脑电图检查,观察不同脑区各个频段波的相对功率特点,并收集患者一般资料。根据是否合并抑郁将患者分为抑郁组和非抑郁组,采用多元Logistic回归分析法分析脑卒中患者合并抑郁的可能的影响因素。结果 72例脑卒中患者中,合并抑郁患者25例,占34.72%;未合并抑郁患者47例,占65.28%。单因素分析结果显示,抑郁组患者伴有糖尿病患者占比、卒中量表(NIHSS)评分、额区及颞区δ波相对功率均显著高于非抑郁组,前额叶β1、额区β2、颞区β2、顶区β1波相对功率均显著低于非抑郁组(P0.05)。多元Logistic回归分析结果显示,糖尿病、NIHSS评分、前额叶β1、额区β2、额区δ、颞区β2、颞区δ、顶区β1波相对功率可能是影响脑卒中患者合并抑郁的独立风险因素(P0.05)。结论脑卒中合并抑郁患者脑电图表现主要呈δ波相对功率升高,β波降低,脑电图检查对早期识别卒中合并抑郁患者具有临床价值,合并糖尿病、NIHSS评分及脑电图波相对功率改变可能是脑卒中合并抑郁的独立风险因素。     

小儿抽动症66例的临床与脑电图分析

目的分析脑电图(EEG)检查对小儿抽动症的临床诊断及价值。方法选取我院收诊的小儿抽动症患儿66例,对其EEG检查结果进行回顾性分析,观察EEG检查对于患儿的临床诊断的价值。结果本组66例患儿,EEG检查结果,在正常范围的患儿48例,异常18例;EEG的异常表现:背景活动轻度非特异性异常患儿14例,其中包括α波指数有减少,基本节律比同龄儿童较慢;阵发性异常患儿5例,其中包括棘慢波、尖波、中央区、额区、颞区少量散发棘波;描记时实时的记录抽动发动32例,且同期AEEG、EEG未发现同步发作性异常波,在抽动前后,发现脑波无明显的改变。其中48例患者进行头颅MRI或CT检查,未发现异常。结论 EEG检查可用于小儿抽动症的诊断以及鉴别诊断中,为临床诊断该病提供重要依据,是一种可靠的辅助检测手段。     

深部脑电图在七氟醚麻醉条件下的(痫)样放电波幅变异

目的:比较七氟醚在不同麻醉深度下对颞叶癫(痫)手术术中深部电极描记的EEG的影响.方法:颞叶癫(痫)行射频热凝毁损手术患者68例,在七氟醚吸入麻醉,最小肺泡浓度(MAC) =0.6时监测额叶皮质EEG和颞叶深部EEG,再加深麻醉至MAC=1.2时再监测.EEG数据应用快速傅里叶处理(FFT),计算额叶背景平均波幅,测量10个颞叶内侧棘波的波幅,取平均值后确定为该患者的棘波波幅,对MAC=0.6和MAC=1.2两组进行统计.结果:MAC=0.6时颞叶内侧棘波放电波幅平均为(426.2±63.1)μV,额叶10～12 Hz(80.3±16.4)μV背景波幅显著；MAC=1.2时颞叶内侧棘波放电波幅平均为(171.2±32.6)μV,额叶10～12 Hz(550.3±126.8)μV背景波幅显著,两组间的(痫)样放电波幅和额叶背景波幅比较差异均有统计学意义(P＜0.05).MAC≤1.2时,七氟醚吸入麻醉影响背景节律和(痫)样放电的波幅,对频率和波形无明显影响.结论:七氟醚麻醉对深部电极EEG的影响呈剂量依赖性,麻醉过深则可能导致(痫)样放电鉴别困难.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.