中央区纵裂癫痫症状学和脑电图研究

目的 探讨中央区纵裂癫痫患者症状学表现及视频脑电图、加密电极脑电图、颅内电极脑电图的特征.方法 对2007年6月至2009年8月确诊为中央区纵裂癫痫并经手术治疗的9例患者资料进行回顾性分析.通过病历采集、视频录像及各种脑电图检查记录,汇总分析各例患者的癫痫发作症状和脑电图特点.结果 中央区纵裂癫痫患者病史长,癫痫发作持续时间短,发作频繁而智力受损不明显,多伴有下肢过度运动发作.头皮脑电图显示中线区域放电,波幅低平.纵裂内皮质脑电显示超高波幅节律规整的慢尖波.全部患者术后均达Engel Ⅰ级.结论 中央区纵裂癫痫患者癫痫发作症状特异,各种脑电图在不同时相、波幅、节律、导联配置等多方面具有独特表现.     

颅内电极监测对顽固性颞叶癫痫致痫灶的定位价值

目的:探讨发作期及发作间期颅内电极监测对癫痫灶的定位作用。方法:20例难治性颞叶癫痫,经临床、影像学及头皮脑电图不能确定致痫灶部位,应用立体定向技术,在患者双侧颞叶植入硬膜下条状电极,进行长时间视频脑电图监测,记录发作期和发作间期的脑电图变化,并与头皮脑电图、MRI进行比较,分析癫痫灶部位,进行手术治疗,术后跟踪随访,评估致痫灶定位的准确性。结果:20例癫痫病人颅内电极埋藏时间1～5天,每个患者至少监测到2次临床发作,每一病例均记录发作间期和发作期的异常放电活动。15例发作间期与发作期定侧一致,2例发作间期为双侧棘波病灶,3例发作间期定位与发作期不一致。按Engel术后效果分级:手术效果满意(癫痫发作消失)13例(65%),显著改善3例(15%),良好3例(15%),无效1例(5%)。所有病例均未出现因颅内电极埋藏而致的并发症。结论:对于致痫灶不能定位的难治性癫痫,应用颅内电极记录方法,尤其是发作期起始时脑电图变化,可以确定致痫灶位置,为癫痫手术治疗提供可靠的依据。     

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。     

额叶癫痫的特点及手术治疗

目的 :分析额叶癫痫的临床特征、发作期及发作间期脑电图特点 ,探讨额叶癫痫手术治疗。方法 :应用视频脑电图对 9例额叶癫痫患者进行长程监测 ,并对其中 6例记录颅内脑电图。分析癫痫发作的临床表现及脑电图特点 ,定位致痫灶 ,行手术切除。结果 :额叶癫痫的发作特点为 :发作频繁而短暂 ,以睡眠期发作为主 ,常见过度运动 ,姿势性强直 ,发声等发作症状。发作期可见棘波节律 ,广泛低幅快活动 ,节律性慢波等特征性脑电活动。颅内电极记录可清晰显示异常脑电活动的发作起源及扩散情况 ,有助于定位致痫灶。手术切除病灶及致痫灶 ,效果满意。结论 :额叶癫痫是一组具有特征性的癫痫综合征 ,颅内电极记录有助于揭示其脑电活动变化。对于难治疗性额叶癫痫 ,准确定位致痫灶是手术成功的关键。     

伴有中央-颞区局灶棘波儿童良性癫痫的动态脑电图研究

目的 探讨伴有中央-颞区局灶棘波儿童良性癫痫(BECT)的脑电图特征.方法 对115例BECT患儿进行动态脑电图检查,并对检查结果及临床表现进行分析.结果 BECT主要表现为面部抽搐、流涎、喉咙发声、发作性肢体阵挛或强直,发作与睡眠密切相关.脑电图背景活动正常,发作间期脑电图一侧或双侧中央-颞区出现棘波或尖波,可向其它部位扩散,还可从一侧半球转移至对侧半球.入睡后局灶放电频率明显增多.结论 BECT临床发作和睡眠密切相关.脑电图是诊断本病的主要依据,动态脑电图可提高脑电图诊断的阳性率.     

用深部脑电图记录小尖棘波

棘波和尖波是脑电图的重要诊断的特征,在发作间期的脑电图中这些短暂的现象常常表示癫痫发作倾向.棘波活动的一种类型Gibbs和Gibbs(1952)称为小尖棘波(Small sharp spikes SSS)不少著者认为在成人的脑电图中常常遇见,对癫痫发作的诊断或定位没有重要意义.本文著者的目的是确定SSS的大脑起源,叙述在深部脑电图(DEEG)中SSS的特征,对照头后脑电图和在DEEG中SSS的特征,以及对比DEEG中记录的SSS和颞叶尖波的特征.著者用EEG及DEEG观察了两例顽固发作的可能选作外科治疗的病人.深部电极是由除尖端1     

同步脑电图-功能磁共振成像技术在癫痫灶定位中的应用研究

目的 探讨同步脑电图-功能磁共振成像技术(EEG-fMRI)在癫痫灶定位中的作用.方法 13例难治性癫痫患者接受同步EEG-fMRI检查,根据EEG出现癫痫波的时间点作为事件相关时间曲线对fMRI数据进行分析,了解发作间期癫痫样放电时血氧水平依赖信号变化所引起的脑部激活情况,并分析这些区域与神经电生理记录所确定的癫痫灶之间的吻合程度.结果 9例患者癫痫样放电在fMRI上的激活区与皮质电极确定的癫痫灶一致;4例患者癫痫样放电在fMRI上的激活区范围大于皮质电极确定的癫痫灶范围,但最强激活区的位置仍与皮质电极确定的癫痫灶一致.结论 同步EEG-fMRI技术将癫痫灶的功能定位与解剖定位相结合,是一种无创、精确度较高的癫痫灶定位方法 .     

儿童良性癫痫伴中央颞区棘波患者发作期脑电图特点分析

目的了解儿童良性癫痫伴中央颞区棘波(benign epilepsy with centrotemporal spikes in children,BECT)的发作期脑电图。方法利用5a时间收集605例BECT患者的临床和脑电图资料。结果 30例患者出现30次癫痫发作。这些患者发作期EEG被分为4种发作期图形。最多的一种类型为A型,12例出现,低电压快节律棘波,波幅逐渐增高节律逐渐变慢。B型,7例次,棘波混合尖波频率和波幅逐渐增高。C型,6例次,θ波波幅逐渐增高和频率逐渐减慢。D型,5例次,局部电活动减弱,继之为前3型。结论虽发作间期BECT脑电图相似,均呈中央颞区放电,BECT发作期图形不是唯一不变的;发作前脑电图电抑制和发作后慢波比较常见,不影响BECT的诊断;发作前图形、发作中脑电图可以相互转化,不影响BECT的诊断。     

皮质发育不良癫(痫)发作间期脑电图在术前评估的定位价值

目的:探讨头皮脑电图(EEG)在局灶性皮质发育不良(focal cortical dysplasia,FCD)癫(痫)病人发作间期的特点及定位致(痫)区的意义.方法:选择自2010年5月～2013年5月我中心收治的50例行颅内电极埋置术,并经病理证实为FCD的患者为研究对象.将颅内电极脑电图(intracranial e-lectrodes EEG,IEEG)发作间期放电(interictal discharge,IID)与头皮脑电图(EEG) IID分为四种类型:A型独立棘波;B型重复棘慢波;C型多棘波;D型阵发性快活动.IEEG发作期放电(ictal discharg,ID)分为3型:Ⅰ型阵发性快活动;Ⅱ型棘波节律;Ⅲ型小于8 Hz的节律性电活动.将50例患者头皮EEG-IID与IEEG-ID分析比较.结果:50例头皮EEG-IID的A、B、C、D各型的波形、部位与IEEG-ID相比,其间均有显著性差异.6例头皮EEG-IID在D型中,5例IEEG-ID为Ⅰ型,术后随访预后均为EngleⅠ级;10例头皮EEG-ID在C型中,7例IEEG-ID为Ⅰ型,术后随访为Engle Ⅰ级的6例;C、D型Engle Ⅰ级1 2例.而头皮EEG-IID中A型16例,术后随访EngleⅠ级的4例,定位意义明显弱于其它类型.结论:50例中头皮EEG-IID以棘波、尖波波形较为多见,且范围较IEEG-IID广泛.经过由皮层到头皮的传导,不论是IID还是ID,异常放电形式均有可能发生改变.头皮EEG的C、D型IID较为局限,定位可靠性较高.     

外伤性癫痫的临床特征分析及手术治疗

目的 总结外伤性癫痫的临床特征及手术效果。方法 对病人进行神经学检查及EEG、CT、MRI及ECT检查，确定致痫灶后手术治疗，手术中行皮层及深部脑电监测。结果 外伤性癫痫病人32例，年龄10至45岁。临床主要表现有全身强直痉挛性发作、部分性发作、精神运动发作、失神发作。头皮脑电图显示32例病人中30例患者有与损伤部位或对冲部位相符的恒定局限性高波幅尖波、棘波和棘慢波。所有病人均在皮层及深部脑电监测下切除病灶。术后15例已完全停止发作，16例已明显好转，1例无明显改变。结论 外伤性癫痫的临床特点包括局灶性发作多见，癫痫发作形式多样和致痫灶在影像学改变附近。手术切除病灶能获良好效果。     

Computerized electroencephalogram

Computer analysis of the electroencephalogram (CEEG) in psychotic children before and after pharmacotherapy, normal children of schizophrenic mothers, and matched normal children of normal parents indicated significant intergroup differences. The psychotic children had more slow, as well as very fast, EEG waves. With drug therapy the EEG showed a partial normalization, as fast EEG activity decreased. The EEG and auditory evoked potential of children of schizophrenic mothers were strikingly similar to those of psychotic children and schizophrenic adults, with significant decreases of the average EEG amplitude and the evoked potential latencies. Psychotic children were distinctly differentiated from the normal children by discriminant function analysis of the EEG and EP. Quantitative analysis of brain functions in the mentally ill can help determine the neurophysiological correlates of behavior, a more scientific diagnostic classification, prognosis, and selection of therapy.This paper was supported in part by the USPHS grant MH-25,669 and presented in part at the Conference on Severe Psychopathologies in Childhood, December 7–8, 1973, New York, New York.     

The postictal electroencephalogram

Postictal phenomena, their laterality and duration, were studied among 51 patients with scalp EEG-recorded seizures whose origin, evolution and postictal phase were clearly depicted. Regional delta was the most common postictal change (PIC), appearing in 29 patients (57%). Regional attenuation occurred in 15 cases (29%) while the EEG reverted immediately to its interictal nature in 16 instances (31%). 'Activation' of spikes postictally occurred after 13 of the 51 seizures (25%), always over the lobe of seizure onset. PIC, whatever its nature, appeared principally or exclusively ipsilateral to seizure origin in all 35 patients. Moreover, when such changes were bilaterally distributed, they persisted longer on the side of seizure origin in all but one case when durations were bilaterally equal. A multiple PIC (greater than 1 phenomenon) occurred after 21 seizures (41%) while a single change appeared after 14 attacks (27%). Multiple changes occurred more commonly when the seizures had evolved to independent bilateral seizures or to grand mal (77%) than when they were confined to the hemisphere of origin (14%). Thus multiple changes were more often distributed bilaterally (90%) than were single changes (29%). Conversely, seizures without any propagation (focal only) were those most likely to show no postictal change. Multiple changes lasted longer (mean 406 sec) than single changes (79 sec), but duration of PIC was unaffected by seizure propagation or its nature, except for grand mal. Seizure duration had no effect on PIC duration except for grand mal attacks whose postictal effects were predictably longer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Propofol and the electroencephalogram

Propofol is an emulsion formulation of 2,6 diisopropylphenol developed in 1975. Widely recognized, it offers beneficial effects compared with other sedative drugs. Propofol is used in several clinical situations including multiple surgical procedures and critical-care medical conditions. Since technological advances over recent years have allowed an ever-increasing number of patients undergoing propofol therapy to be monitored by using continuous digital EEG, it is important to have a complete understanding of the effects of propofol on EEG in diverse clinical scenarios. This paper presents a review of the effects of propofol in electroencephalograms and discusses proconvulsive, anticonvulsive proprieties and the EEG findings in different medical conditions.     

癫(癎)持续状态与脑电图

癫(癎)持续状态(SE)是神经科常见急症之一,若不能尽早终止发作,可导致神经元永久性损害和患者死亡[1-4].除基础病因、年龄等因素外,癫(癎)持续状态持续时间是影响预后的重要因素.根据癫(癎)持续状态的实验研究及临床观察发现,癫(癎)发作持续时间>30 min,即会演变得难以控制[5].