非癫痫发作患儿120例视频脑电图诊断分析

目的：对120例非癫痫发作儿童视频脑电图结果进行分析,为该类疾病的诊断提供参考。方法选取2012-10-2014-04于昆明市儿童医院神经内科行视频脑电图检查的1305例患儿中,有临床发作,但发作期同步脑电图正常,未见癫痫放电的120例非痫样发作患儿进行分析。结果行视频脑电图检查的1305例患儿中,有临床发作,但发作期同步脑电图正常,未见癫痫放电的非痫样发作患儿120例。其中N ES合并癫痫12例,7例无癫痫病史也无发作时癫痫样放电,但存在与临床不同步的非发作期的颠痫样放电。结论癫痫性发作及非癫痫性发作治疗原则不同,临床上必须正确判断,通过V-EEG可仔细分析发作时临床表现其与EEG的关系,可对发作性质作出准确判断,为临床治疗提供依据。     

视频脑电图在假性癫痫发作诊断中的价值

假性癫痫发作系指在各种诱因下 (情绪原因为主 )出现的类似癫痫发作的非癫痫发作 ,常易误诊。现将我院经视频脑电图监测诊断的 16例假性癫痫发作患者进行回顾性分析 ,并与 16例癫痫患者比较 ,探讨视频脑电图鉴别假性癫痫的价值。资料和方法 :16例假性癫痫发作患者 ,男 4例 ,女 12例 ,年龄 2 1～ 6 5岁 ,平均 42岁 ,均为视频脑电图检查前临床诊断为癫痫的患者。临床分型 :全身强直 阵挛性发作 11例 ,复杂部分性发作 3例 ,单纯部分性发作 2例。病程 1ｄ至 2 0年。同时选择临床确诊且视频脑电图监测到发作的 16例患者 ,男 9例 ,女 7例 ,年龄 1…     

头痛型癫痫的临床表现和脑电图分析

目的：探讨头痛型癫痫的临床和脑电图表现及预后。方法：本文报告53例头痛型癫痫，病程2周-7年，全部患者发作或发作间歇期均作神经系统检查和多次脑电图及头颅CT检查。结果：发作时表现为剧烈头痛，缓解后无特殊不适。神经系统检查和头颅CT查未见异常，头痛发作和间歇期作常规或睡眠诱发的脑电图检查，均可获痫性放电。结论：头痛型癫痫是植物神经发作中常见的发作类型，其唯一发作表现是头痛，病变部位与下丘脑，颞叶、边缘系统有关。脑电图检查对诊断和鉴别诊断有重要意义。诊断时切忌将功能性或血管性头痛误诊为头痛型癫痫。     

额颞叶癫痫临床下发作的脑电图分析

目的 分析额颞叶起源癫痫临床下发作的脑电图特点及临床意义。方法 收集2020年1月—2021年1月就诊于天津医科大学总医院神经内科门诊及住院的通过24小时视频脑电图监测存在临床下发作的癫痫患者,分析脑电图在发作持续时间、发作次数、发作时间（睡眠期/清醒期）、发作间期放电、发作累及导联数方面的特点及临床意义。结果 共纳入18例患者,捕捉到临床下发作280次（11/18）、临床发作34次（9/18）,其中2例患者同时存在临床下发作及临床发作。额叶起源：临床下发作235次、临床发作15次;颞叶起源：临床下发作26次、临床发作19次;额颞叶起源：临床下发作19次、未捕捉到临床发作。临床下发作组中（11/18）：睡眠期发作163次（58.2%）、清醒期发作117次（41.8%）;临床发作组中（9/18）：睡眠期发作16次（47.1%）、清醒期发作18次（52.9%）。在发作累及导联数中：<6个导联,临床下发作270次、未发现临床发作;≥6个导联,临床下发作10次、临床发作34次。在总癫痫发作持续时间中：临床发作组为（27.43±17.73）s,中位数值30 s;临床下发作组为（20.10±...     

癫痫伴肌阵挛-失张力发作的临床及脑电图特征分析

目的探讨癫痫伴肌阵挛-失张力发作(epilepsy with myoclonic-atonic seizures,EMAS)的临床及视频脑电图特点,以提高对该病的认识。方法对2017年12月-2018年12月吉林大学白求恩第一医院小儿神经科收治的6例EMAS患儿临床及脑电特征进行回顾性分析。结果 6例EMAS患儿中,男5例,女1例;发病前智力运动发育正常,影像学正常。发病年龄2岁2个月～6岁,确诊时间2个月～1年6个月。6例患儿至少有肌阵挛、肌阵挛-失张力、失张力发作、不典型失神发作中两种发作形式。其中4例在上述发作前或后出现强直-阵挛发作,1例在病程晚期有强直发作。6例患儿中5例背景活动正常; 1例背景活动偏慢。6例患儿的脑电图在清醒期及睡眠期均出现广泛性2～4 Hz棘慢波、多棘慢波不规则或节律性发放,睡眠期放电有时类似高度失律,均无局灶性发作。所有患儿影像学检查均正常。6例患儿均给予正规抗癫痫药物治疗,其中2例治疗反应良好,4例治疗无效后给予甲基强的松龙治疗,其中3例有效缓解,1例虽然没有发作仍有大量放电。结论 EMAS好发于学龄前期儿童,癫痫发作类型主要包括肌阵挛、失张力或肌阵挛-失张力发作,但不典型失神等,脑电图主要为广泛性棘慢波、多棘慢波发放,治疗以抗癫痫药物和激素治疗为主,预后相对较好。     

额叶癫痫发作临床表现及脑电改变特征的分析

目的 探讨额叶癫痫发作临床表现及脑电改变特征。方法 利用ＺＮ８０００型同步录像脑电图（ＥＥＧ）对１０例额叶癫痫患者进行脑电和行为监测。结果 监测时间内共监测到８９次临床发作,睡眠６２次,清醒２７次,持续时间１０～９０秒。临床表现：单纯部分性发作３例１２次,复杂部分性发作６例７０次,强直－阵挛性发作１例７次;发作期ＥＥＧ：额区或额区为主的癫痫样放电（棘波、尖波、棘慢、尖慢综合波）８例７１次,高极高幅     

视频脑电图对儿童非癫痫发作的诊断意义

目的 探讨儿童非癫(疒间)发作(non-epileptic seizures ,NES)的临床特征及视频脑电图(Video-EEG, V-EEG)对其诊断的意义.方法 采用北京太阳公司SOLAR2000B床旁监护仪,对2006-06～2009-06,经V-EEG监测后诊断为NES患儿26例进行分析.结果 本组V-EEG正常19例(73.1%),异常7例(26.9%).其中轻度异常4例,中度异常1例,发作间歇期(疒间)样波2例.发作频率:1次者16例,2次4例,3次以上6例.发作时相:清醒期发作23例(88.5%),睡眠期发作1例,清醒期、睡眠期均有发作2例.结论 V-EEG对NES的诊断和鉴别诊断均优于常规脑电图(REEG)和动态脑电图(AEEG),对诊断NES提供了客观的科学依据,是诊断癫(疒间),明确癫(疒间)发作分类,鉴别癫(疒间)与儿童NES的最有效检查方法.被认为是儿童NES诊断的金标准.     

缺氧缺血性脑病中的癫痫发作临床表现、脑电图、治疗及预后

心脏疾病、麻醉意外、一氧化碳中毒、失血性休克、肺部疾病、自缢、溺水等造成的心肺骤停是成人缺氧缺血性脑病(Anoxic-ischemic encephMopathy,AIE)的常见原因.近年来,随着急救措施的进步,心肺骤停的患者得以成功复苏,但脑部缺氧缺血却带来了神经系统的许多并发症,如智力迟钝、记忆力下降、运动障碍等.癫痫发作是这类脑病中最为重要的临床表现之一,而其发作又会加重脑部缺血缺氧,严重影响患者的预后.了解其临床和脑电图特点,寻找有效的治疗措施,将改善此类患者的预后.     

转换障碍伴类似癫痫发作误诊1例

本文目的是为心因性假性癫痫发作（PNES）的早期诊断、鉴别及治疗提供参考。PNES是转换障碍最常见临床表现之一,常于患者情绪激动或受暗示时突然发病,表现类似癫痫发作,但并无大脑异常的癫痫样放电活动。本案例报道了一例中年女性多次出现类似癫痫发作,结合病史及辅助检查诊断为“转换障碍-心因性假性癫痫发作”,经对症治疗后病情好转。     

非癫痫性强直样发作患儿的临床与脑电图分析

非癫痫性强直样发作是一种发作性的重复性行为,发作形式多样,属正常婴儿发育过程中可以见到的一种行为现象,随年龄增大逐渐消失。临床医生容易将其误诊为癫痫发作及低钙抽搐。为避免滥用补钙及抗癫痫药物．消除家长顾虑,本文将我院2001年至2004年儿科收治的16例非癫痫性强直样发作患儿的脑电图结果与临床分析报告如下：     

Juvenile and adult-onset psychogenic non-epileptic seizures

Purpose

Psychogenic non-epileptic seizures (PNES) tend to begin in adolescence and young adulthood, although the seizures can occur in a wide range of ages. In the current study, we investigated the age of onset in patients with PNES and tried to determine the correlation between the age of onset and the demographic and clinical characteristics and factors potentially predisposing to PNES.

Methods

In this cross-sectional study, all patients with a clinical diagnosis of PNES were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2012. We dichotomized the patients into two groups; those with age of onset below 18 years (juvenile), and those with age of onset at 18–55 years (adult-onset). We studied the demographic and clinical characteristics and factors potentially predisposing to PNES between these two groups. Statistical analyses were performed using Chi square and Fisher's Exact tests and Mann–Whitney U test.

Results

Fifty-seven patients with juvenile and 129 people with adult-onset PNES were studied. Demographic characteristics of these two groups were not different significantly. Seizure characteristics and semiology in these two groups were not significantly different either. However, factors potentially predisposing to PNES were significantly different between these two groups. History of being abused, academic failure, epilepsy or family history of epilepsy were more frequently observed in juvenile PNES, while medical comorbidities were more frequent among patients with adult-onset PNES.

Conclusion

Age of onset of PNES is not correlated with the clinical manifestations; however, factors potentially predisposing to PNES are significantly different in patients with juvenile compared to those with adult-onset PNES.     

Tonic and atonic seizures: Medical therapy and ketogenic diet

Tonic and atonic seizures are typically seen in what are often referred to as the catastrophic epilepsies. In simply considering what each of the terms signifies (either the complete loss of tone or a marked increase in tone), they would appear to be at the most diverse ends of the spectrum. They would appear to be as opposite as hot and cold or hard and soft. And yet they are often found to occur in the same patient. This article examines the nature of these seizures and discusses some of the syndromes in which they are seen. Although these seizures are often very difficult to control, some of our medications/therapies have been shown to be effective. Recommendations concerning the efficacy of these therapies and a review of the newer therapies are provided. In addition, the ketogenic diet has been particularly successful in treating these seizures; this is discussed in some detail. Finally, although outcomes for these children are generally less than ideal, many can be helped with a persistent approach that balances seizure control against the side effects of medication.     

Technical standards for recording and interpretation of neonatal electroencephalogram in clinical practice

Neonatal electroencephalogram (EEG), though often perceived as being difficult to record and interpret, is relatively easy to study due to the immature nature of the brain, which expresses only a few well-defined set of patterns. The EEG interpreter needs to be aware of the maturational changes as well as the effect of pathological processes and medication on brain activity. It gives valuable information for the treatment and prognostication in encephalopathic neonates. In this group, serial EEGs or EEG monitoring often gives additional information regarding deterioration/improvement of the brain function or occurrence of seizures.     

Psychogenic pseudoepileptic seizures: clinical and electroencephalogram (EEG) video-tape recordings

This paper presents a clinical and electrophysiological analysis of type and duration of seizures recorded by means of long-term video electroencephalogram (EEG) monitoring, a method which enables accurate diagnosis of psychogenic pseudoepileptic seizures occurring with or without epileptic seizures. Analysis is based on 1083 patients, hospitalized at our department between 1990 and 1997, with a preliminary diagnosis of epilepsy. Psychogenic pseudoepileptic seizures were diagnosed in 85 patients (7.8%). In 48 patients, pseudoepileptic seizures alone were diagnosed (group 1), whereas 37 patients had a mixed condition in which pseudoepileptic seizures were accompanied by epileptic seizures (group 2). For comparison of duration of pseudo- and epileptic seizures a control group (group 3), consisting of 55 patients randomly selected from the population of patients suffering from epileptic seizures alone, was parceled out. Long-term video EEG monitoring was performed in 70 patients. In 55 (79%) of these patients 230 seizures (221 pseudoepileptic and nine epileptic) were recorded. In 30 patients (32%), the diagnosis was based on clinical observation of the seizures and on the number of EEG recordings, including activating procedures such as sleep deprivation, photostimulation, hyperventilation and anti-epileptic drug withdrawal. We found that the duration of epileptic seizures was significantly shorter than the duration of psychogenic pseudoepileptic seizures. Our study has exposed the difficulties involved in the diagnosis of psychogenic pseudoepileptic seizures and the negligible value of neuroimaging techniques and interictal EEG recordings in the differential diagnosis of epileptic versus nonepileptic seizures. In this study, psychogenic seizures were significantly more frequent in women than in men; patient history analysis did not confirm the hypothesis that sexual abuse may cause psychogenic seizures.     

Hyperthermic seizures and hyperthermia in immature rats modify the subsequent pentylenetetrazole-induced seizures

It has been described that febrile seizures during infancy increase risk of subsequent non-febrile seizures during the adulthood. However, latency period between febrile seizure and the onset of the first spontaneous seizure has not been evaluated. The present study was designed to investigate the susceptibility to subsequent seizures in immature rats that had experienced early-life hyperthermic seizures and before they achieved the adult age. The results were compared with those induced by hyperthermia alone. Pentylenetetrazol (PTZ) was applied 24 h or 20 days after hyperthermic seizures or hyperthermia were induced in 10-day-old rats by a regulated stream of moderately heated air. One day after hyperthermic seizures or hyperthermia, animals demonstrated enhanced latency to the PTZ-induced myoclonic (88% and 53%, respectively), clonic (60% and 60%, respectively) and tonic seizures (233% and 659%, respectively). The incidence of myoclonic and clonic seizures was similar to that in control group (100%). However, hyperthermic seizures reduced (50%) the incidence of tonic seizures. Twenty days after hyperthermic seizures there was an augmented latency to tonic seizures (123%) and reduced incidence for all the PTZ-induced seizures (71% myoclonic; 71% clonic seizures; 57% tonic seizures) when compared with control group (100%). In contrast, hyperthermia enhanced only the latency to myoclonic (133%) and clonic seizures (659%). Our data indicate that hyperthermic seizures or hyperthermia induces a protective effect against PTZ-induced seizures during a latency period. A possible involvement of γ-aminobutyric acid (GABA) system is discussed.     

Hyperkinetic seizures in patients with temporal lobe epilepsy: clinical features and outcome after temporal lobe resection

Purpose: Temporal lobe epilepsy (TLE) is usually associated with automatisms. Hyperkinetic seizures are supposed to be unusual. Because we witnessed several patients with TLE and ictal hyperkinetic symptoms, we retrospectively assessed the number, clinical findings, and seizure outcome in such patients who had undergone temporal lobe resection. Methods: We reviewed medical history, video–electroencephalography (EEG) recording and neuroimaging of adult patients who underwent epilepsy surgery for TLE at the Kork Epilepsy Center over the last 20 years with a minimum postoperative follow‐up of 12 months. Key Findings: Among 294 patients who were resected exclusively in the temporal region, we identified 17 (6%) who presented with hyperkinetic semiology such as violent vocalization, complex movements of the proximal segments of the limbs, rotation of the trunk, pelvic thrusting, or early tonic or dystonic posturing. Most of the patients had a preceding aura. Ictal EEG activity was located in the corresponding temporal region, usually with a wide distribution over temporal electrodes with fast spread to unilateral frontal electrodes and to the contralateral side. Neuroimaging revealed extended lesions in the temporal lobe involving mesial and neocortical structures. Most of the patients underwent classical anterior temporal lobe resection including amygdalo‐hippocampectomy. Fourteen patients (82%) became completely seizure‐free (Engel class Ia). Histopathology showed mainly focal cortical dysplasia plus hippocampal sclerosis. Significance: Hyperkinetic seizure semiology may occasionally occur in patients with TLE and is, therefore, no contradiction to the hypothesis of TLE if scalp EEG patterns and neuroimaging findings correspond. The postoperative seizure outcome is favorable in such patients and not different from outcome data in classical TLE.     

Factors influencing clinical features of absence seizures

Purpose: The clinical features of absence seizures in idiopathic generalized epilepsy have been held to be syndrome‐specific. This hypothesis is central to many aspects of epilepsy research yet has not been critically assessed. We examined whether specific factors such as epilepsy syndrome, age, and state determine the features of absence seizures. Methods: Children with newly presenting absence seizures were studied using video electroencephalography (EEG) recording. We analyzed whether a child's epilepsy syndrome, age, state of arousal, and provocation influenced specific clinical features of their absence seizures: duration, eyelid movements, eye opening, and level of awareness during the seizure. Results: Seizures (509) were evaluated in 70 children with the following syndromes: Childhood absence epilepsy (CAE), 37; CAE plus photoparoxysmal response (PPR), 10; juvenile absence epilepsy (JAE), 8; juvenile myoclonic epilepsy (JME), 6; unclassified, 9. Seizure duration was associated with epilepsy syndrome as children with JME had shorter seizures than in other syndromes, independent of age. Age independently influences level of awareness and eye opening. Arousal or provocation affected all features except level of awareness. Specific factors unique to the child independently influenced all features; the nature of these factors has not been identified. Discussion: The view that the clinical features of absence seizures have syndrome‐specific patterns is not supported by critical analysis. We show that confounding variables profoundly affect clinical features and that syndromes also show marked variation. Variation in clinical features of absence seizures results from a complex interaction of many factors that are likely to be genetically and environmentally determined.     

脑小血管病的病变分布特征与临床表现的关系

目的分析脑小血管病(CSVD)患者病变分布特征与临床表现的关系。方法选取2011-08—2014-08在我院收治的小脑血管疾病患者140例,根据ARWMC评分将病情程度分为轻度组、中度组和重度组;根据病变部位分为皮层下、基底节区以及脑干和小脑区。分析不同病情程度与病变部位的关系以及不同病变部位和临床表现的关系。结果轻度组基底节区发病率12.29%,中度组为32.61%,重度组为52.94%,差异有统计学意义(P0.05),而皮层下及脑干和小脑区发病率无显著差异(P0.05)。不同病变部位的认知功能损害、头晕及眩晕、步态障碍、卒中和TIA史差异有统计学意义(P0.05),尿失禁发生率无显著差异(P0.05)。结论脑小血管疾病的不同病变区域病情程度有所差异,且临床表现有所不同,分析其相关性对临床预防及诊治有重要意义。     

Clinical utility of EEG in alcohol-related seizures

OBJECTIVE: To study if electroencephalogram (EEG) can discriminate between alcohol-related seizures (ARS) and seizures unrelated to alcohol use. MATERIAL AND METHODS: Alcohol-related seizures was defined as a seizure in a patient with score > or = 8 in the Alcohol Use Disorders Identification Test (AUDIT). Twenty-seven patients with ARS (22 without epilepsy: ARSwE), 21 AUDIT-negative epileptic patients with seizures (ES), and 30 other AUDIT negative patients with seizures (OS) were studied. Thirty-seven epilepsy outpatients and 79 sciatica inpatients were controls. RESULTS: Epileptiform and slow activity were less frequent in the ARSwE than in the ES group. Alpha amplitude was lower in the ARSwE than the other groups. Photoparoxysmal activity was not observed. EEG was associated with a larger negative predictive value (78% probability of non-ARS if EEG was abnormal) than a positive predictive value (55% probability of ARS if EEG was normal). CONCLUSION: A definitely abnormal EEG suggests epilepsy or symptomatic seizures unrelated to alcohol. The predictive value of a normal EEG is limited, but the typical post-ictal finding in ARS is nevertheless a normal low-amplitude EEG record.     

2例非惊厥癫痫持续状态患者的临床特征及脑电图分析

非惊厥性癫痫持续状态（Nonconvulsive Status Epilepticus,NCSE）年发病率为5.6～18.3/10万[1],约占癫痫持续状态的一半,并非罕见,以往由于对其认识不足和诊断标准不一致[2],常被误诊或漏诊,得不到及时有效的治疗.不同类型的NCSE,临床表现和脑电图特点各不相同[3].现将首都医科大学宣武医院神经内科2012年7～10月收治的2例NCSE患者的临床特征及脑电图结果报道如下.