颅内电极监测癫痫发作初始期脑电定位意义

目的 探讨颅内电极监测癫痫发作初始期脑电对致痫灶的定位价值。方法 14例难治性癫痫患，其临床，影像学检查及头皮脑电记录等不能精确定位致痫灶，经颅骨钻孔，埋置颅内深部和／或皮层电极，长程脑电监测并分析发作初始期脑电的异常放电节律和范围，对比术后病理学检查和随访结果，分析发作初期脑电定位致痫灶的准确性。结果 记录到47次临床发作。发作初期异常放电可分为4种形式；低幅愉节律，尖波节律，高幅棘波节律和棘慢波节律。按异常放电范围可分为：局限性放电，区域性放电和广泛性放电，11例（78．5％），患准确定位了致痫灶，术后癫痫发作消失（64．3％）或极少发作（14．2％），2例（14．2％）发作减少90％以上，1例（7．1％）术后无改善。结论 颅内埋置电极脑电监测癫痫发作初始期异常放电形式，部位和异常放电范围是定位致痫灶可靠的方法。     

术中皮层脑电监测对难治性癫痫致痫灶定位的价值

目的:探讨癫痫手术中皮层脑电图监测指导切除致痫灶的应用价值.方法:2007年3月至2010年8月期间36例难治性癫痫患者经严格术前评估后,开颅手术治疗.术中在EcoG引导下精确定位致痫灶,确定手术范围,手术切除病灶及其周围的致痫灶.结果:术后随访后随访12～ 449个月.根据Engel疗效分级标准进行疗效评价,Ⅰ级22例,Ⅱ级8例,Ⅲ级4例,Ⅳ级2例,有效率94.4％,显效率83.3％.结论:术中应用EcoG监测能大大提高致痫灶空间定位的准确性,有效地指导癫痫手术.EcoG在不同病理类型的致痫灶中的诊断价值不尽相同,皮质发育不良的术中EcoG应用前景广阔.     

皮层脑电监测下切除致痫灶治疗顽固性癫痫的护理

我院自1993年8月至1997年6月采用在皮质脑电图监测下切除致病灶来治疗顽固性癫痛18例,取得了满意效果。我们体会到手术前后的精心护理是提高治愈率的重要条件,现将护理体会报告如下。1临床资料11一般资料本组18例中,男13例,女5例,年龄9～57岁,平均237岁,病程2～20年,平均56年。发作类型、全身强直性发作10例,复杂性部分发作4例,单纯性部分发作2例,失神发作1例,失张力发作五例。1．2手术效果对其中13例获得术后10个月以上随访,满意6例,显著5例,良好显例,效差1例。术后一侧肢体轻瘫见例,颅内感染1例,术后皮下积液1例。2护82…     

癫痫病人颅内电极埋置术后视频脑电监测期的护理

近年来，难治性癫痫的外科治疗引起了学术界的广泛关注，而癫痫灶定位是手术成功的关键步骤，通过现有的无创方法不能定位者需要应用颅内电极埋置进行长程视频脑电监测(V-EEG)，这一技术被认为是目前定位癫痫灶的最佳方法。本文总结了2001年4月-2003年4月期间我科接受颅内电极埋置术的38例难治性癫痫病人资料。现将有关护理体会报告如下。     

颅内电极埋藏术后长程视频脑电监测的护理体会

总结了13例颅内电极埋藏术后行脑电监测的护理措施,包括埋藏术前的护理及准备工作、术后监测过程中的观察及安全护理。认为观察记录及时,完善各项护理措施,是病人安全及顺利完成检查的重要保证,从而为医生提供精确资料,为手术提供准确定位。     

颅内电极埋藏治疗难治性癫痫的围手术期护理

癫痫是最常见的严重脑部疾病.人群患病率约为0.04%,特别是难治性癫痫患者,约占癫痫患者总数的20.0%～25.0%[1].对这类患者,药物控制难以奏效,最好的方法就是进行手术治疗.我院2005年3月～2006年12月为36例患者实施了癫痫手术治疗及精心的围手术期护理,保障了手术顺利进行.现将围手术期护理体会报告如下.     

皮层脑电图监测下致痫灶切除治疗难治性癫痫的护理35例

1993年8月～2000年12月,我院采用皮层脑电图监测下致痫灶切除治疗35例难治性癫痫,取得了满意的效果,现将护理体会报告如下.     

1例颅内电极植入术后行长程视频脑电图监测癫痫患儿的护理

小儿癫痫是小儿时期常见的一种神经系统综合征,是儿科神经系统常见病、多发病,具有临床表现多样且反复发作的特点,对患儿生长发育和生活质量均造成了严重影响[1-2].小儿癫痫的发病率约为3％～6％,其中1/3 的患儿使用药物难以控制,手术治疗适用于对抗癫痫药物治疗效果不佳且进行性加重的难治性癫痫[3].癫痫灶的准确定位是决定...     

三步法定位并多术式联用显微外科手术治疗难治性癫痫

目的探讨难治性癫痫致痫灶定位和手术治疗方法。方法对81例难治性癫痫患者综合运用临床症状学、神经电生理、高场强MRI、PET/CT、术前及术中皮层及深部电极等三步法定位致痫灶,单纯病灶切除、病灶切除加胼胝体切开、病灶切除加软膜下横切、病灶切除加单脑回灰白质联合切除等多术式联用切除致痫灶和/或阻断传导通路。结果三步法致痫灶定侧准确率100%。多术式联用治疗后,满意31例,显著改善17例,良好16例,效差14例,无改善3例,总有效率79.0%。结论三步法可以对致痫灶精确定位,多术式联合处理致痫灶或/和传导通路可以取得良好的疗效。     

癫痫外科核心技术的传承与发展

"我看到了妈妈第一次送我去幼儿园时的情景……",这是7年前一位癫痫患者在埋置了颅内电极以后接受皮层电刺激时能重复的一个故事。也是数百个故事中的一个:应用硬膜下和深部电极记录明确了癫痫发作起源,进一步的皮层电刺激描绘出语言、记忆区。笔者常常感慨皮层电刺激     

电极置入视频脑电图监测对癫痫患者的护理干预

目的探讨癫痫患者颅内电极置入视频监测期的护理方法。方法分析癫痫患者颅内电极置入视频脑电图监测患者的疾病和心理方面的潜在危险因素,制定相应的护理干预计划。结果患者在颅内电极置入视频监测期间主要危险因素为：手术并发症、颅内及伤口感染、癫痫发作导致身体受伤、心理压力。结论对颅内电极置入视频脑电图监测期间的患者实施有计划的、有针对性连续性的系列护理干预程序,促使患者的心身都处于主动接受积极配合治疗的最佳状态,帮助患者安全渡过监测期,可有效减少并发症,有利于患者疾病的康复和提高今后生存的质量。     

24小时动态脑电图在精神运动性癫痫患者诊断中的作用

目的:探讨动态脑电图(AEEG)对精神运动性癫痫的诊断及鉴别诊断价值.方法:分别采取常规脑电图(EEG)和AEEG对60例精神运动性癫痫患者行脑电监测,并进行比较.结果:与EEG相比,AEEG的总异常率和中度异常率有显著性差异 (P<0.01 ).结论:精神运动性癫痫患者在发作间期进行AEEG检查,可提高痫样波的检出率...     

Motion and ballistocardiogram artifact removal for interleaved recording of EEG and EPs during MRI

Artifactsgenerated by motion (e.g., ballistocardiac) of the head inside a high magnetic field corrupt recordings of EEG and EPs. This paper introduces a method for motion artifact cancellation. This method is based on adaptive filtering and takes advantage of piezoelectric motion sensor information to estimate the motion artifact noise. This filter estimates the mapping between motion sensor and EEG space, subtracting the motion-related noise from the raw EEG signal. Due to possible subject motion and changes in electrode impedance, a time-varying mapping of the motion versus EEG is required. We show that this filter is capable of removing both ballistocardiogram and gross motion artifacts, restoring EEG alpha waves (8–13 Hz), and visual evoked potentials (VEPs). This adaptive filter outperforms the simple band-pass filter for alpha detection because it is also capable of reducing noise within the frequency band of interest. In addition, this filter also removes the transient responses normally visible in the EEG window after echo planar image acquisition, observed during interleaved EEG/fMRI recordings. Our adaptive filter approach can be implemented in real-time to allow for continuous monitoring of EEG and fMRI during clinical and cognitive studies.     

Simultaneous MEG and intracranial EEG recordings during attentive reading

The relationship between neural oscillations recorded at various spatial scales remains poorly understood partly due to an overall dearth of studies utilizing simultaneous measurements. In an effort to study quantitative markers of attention during reading, we performed simultaneous magnetoencephalography (MEG) and intracranial electroencephalography (iEEG) recordings in four epileptic patients. Patients were asked to attend to a specific color when presented with an intermixed series of red words and green words, with words of a given color forming a cohesive story. We analyzed alpha, beta, and gamma band oscillatory responses to the word presentation and compared the strength and spatial organization of those responses in both electrophysiological recordings. Time-frequency analysis of iEEG revealed a network of clear attention-modulated high gamma band (50–150 Hz) power increases and alpha/beta (9–25 Hz) suppressions in response to the words. In addition to analyses at the sensor level, MEG time-frequency analysis was performed at the source level using a sliding window beamformer technique. Strong alpha/beta suppressions were observed in MEG reconstructions, in tandem with iEEG effects. While the MEG counterpart of high gamma band enhancement was difficult to interpret at the sensor level in two patients, MEG time-frequency source reconstruction revealed additional activation patterns in accordance with iEEG results. Importantly, iEEG allowed us to confirm that several sources of gamma band modulation observed with MEG were indeed of cortical origin rather than EMG muscular or ocular artifact.     

Feasibility of simultaneous intracranial EEG-fMRI in humans: A safety study

In epilepsy patients who have electrodes implanted in their brains as part of their pre-surgical assessment, simultaneous intracranial EEG and fMRI (icEEG-fMRI) may provide important localising information and improve understanding of the underlying neuropathology. However, patient safety during icEEG-fMRI has not been addressed.Here the potential health hazards associated with icEEG-fMRI were evaluated theoretically and the main risks identified as: mechanical forces on electrodes from transient magnetic effects, tissue heating due to interaction with the pulsed RF fields and tissue stimulation due to interactions with the switched magnetic gradient fields. These potential hazards were examined experimentally in vitro on a Siemens 3 T Trio, 1.5 T Avanto and a GE 3 T Signa Excite scanner using a Brain Products MR compatible EEG system.No electrode flexion was observed. Temperature measurements demonstrated that heating well above guideline limits can occur. However heating could be kept within safe limits (< 1.0 °C) by using a head transmit RF coil, ensuring EEG cable placement to exit the RF coil along its central z-axis, using specific EEG cable lengths and limiting MRI sequence specific absorption rates (SARs). We found that the risk of tissue damage due to RF-induced heating is low provided implant and scanner specific SAR limits are observed with a safety margin used to account for uncertainties (e.g. in scanner-reported SAR). The observed scanner gradient switching induced current (0.08 mA) and charge density (0.2 μC/cm²) were well within safety limits (0.5 mA and 30 μC/cm², respectively). Site-specific testing and a conservative approach to safety are required to avoid the risk of adverse events.     

癫痫司法鉴定案例脑电图分析

目的：探讨癫痫司法鉴定案例的脑电图特征,为司法鉴定提供依据。方法对30例癫痫司法鉴定案例的脑电图检查结果及其他鉴定资料进行回顾性分析。结果本组鉴定案例中癫痫发作类型以全身强直阵挛发作为主（53．3％）,33．3％的患者有责任能力,53．3％的有部分责任能力;脑电图正常率为6．7％,轻度异常率为40．0％,中度异常率为33．3％,重度异常率为20．0％,总异常率为93．0％。结论癫痫司法鉴定案例脑电图异常率较高,多为轻中度异常,脑电图检查是诊断癫痫的重要依据。     

婴幼儿癫痫的临床和脑电图特点分析

目的研究各型婴幼儿癫痫发作特征、脑电图、病因、神经影像学的改变,探讨早期诊断方法及预后。方法对我院2003年6月-2008年1月门诊和住院诊治的125例3岁以内起病的婴幼儿癫痫患儿进行临床观察及脑电图监测,并进行CT或MRI等神经影像学及血生化、尿遗传代谢病筛查等辅助检查,随访治疗效果和远期预后。结果本组1岁以内发病占54．4％。全面性发作占37．6％,局灶性发作占53．6％,不能明确分类的发作占8．8％。症状性癫痫占58．4％,其中围生期异常是第一位病因,占症状性癫痫的50．68％;特发性癫痫占41．6％。脑电图背景活动正常占53．6％,异常占46．4％,发作问期EEG正常占24．8％,异常占75．2％。影像学检查异常占38．4％。结论婴幼儿以症状性癫痫多见,局灶性发作所占的比例高,发作形式多样,应与非癫痫性发作鉴别,视频脑电图检查对诊断及鉴别有重要意义。     

Methodological aspects of functional transcranial Doppler sonography and recommendations for simultaneous EEG recording

The neurovascular coupling describes a vasoregulative principle of the brain that adapts local cerebral blood flow in accordance with the underlying neuronal activity. It is the basis of modern indirect brain imaging techniques. Because of its wide availability and high tolerability the functional transcranial Doppler has been often used to assess brain function in clinical conditions. In the present paper we will give an overview of the current understanding of the coupling, explain basic principles of the Doppler technique and summarize relevant findings of functional Doppler tests in the different vascular territories of the brain. Finally, the concept of a combined functional electroencephalogram and transcranial Doppler technique will be outlined, which allows simultaneous investigation of the neuronal and vascular responses of neurovascular coupling.     

外伤性脑内血肿的微创治疗

目的 探讨微创手术治疗外伤性脑内血肿的适应证和方法。方法 选择经颅脑CT检查确诊的外伤性急性硬膜外血肿、脑内血肿、开颅术后迟发性脑内血肿惠者86例，以术前颅脑CT片为依据，进行术前规划。确立入颅点、置管方向及深度、引流管颅内段相应部位加开侧孔的数目。在病床边于局部麻醉下以快速颅锥钻孔，置引流管于血肿腔内，持续外引流，并向血肿腔内注射尿激酶。术后CT复查。结果 微创操作均于15～25min完成。5d复查CT血肿明显减少（〉85％）38例，基本或完全消失48例。痊愈59例，轻残13例，中残9例，死亡5例。病死率为5．81％。无颅内感染发生。结论 对某些外伤性脑内血肿采用微创手术治疗是可行的。只要适应证选择得当，操作得法，可获良好效果。     

立体定向手术治疗难治性癫痫中的脑电地形图和脑电图分析

报告２３例获得５年以上随访、行术前、术后脑电地形图（ＢＥＡＭ）、脑电图（ＥＥＧ）检查及术中深部脑电图监护的癫痫病例．ＢＥＡＭ明显好转１５例，无改善８例，好转率６５．２％；ＥＥＧ癫痫样放电活动基本消失４例，明显减少１２例，无变化７例，好转率６９．５％；手术效果评价，显效３例，有效１７例，无效３例，临床有效率８６．９％．