录像脑电图监测对发作性疾病的诊断价值

The value of Video-EEG monitoring in diagnosis of paroxysmal events

目的研究录像脑电图(VEEG)在癫的诊断、鉴别诊断和临床发作分型中的价值,探讨癫患者自然睡眠时相与样放电之间的关系。方法使用录像脑电图对93例发作性疾病患者进行长程脑电监测,记录清醒和睡眠时的脑电图,并作诱发试验,明确发作性质,确定癫的临床发作类型,并分析发作间期癫样放电的睡眠-觉醒时相分布。结果93例发作性疾病患者中有临床发作者51例,样放电者72例,结合病史、临床表现和EEG结果而诊断为癫71例,其中69例患者确定了临床发作类型,20例修正了临床发作类型;71例确诊为癫患者中有完整睡眠-觉醒周期者65例,觉醒期有样放电者49例,睡眠期有样放电者61例,其中NREMⅠ-Ⅱ期52例(85.2%),NREMⅠ-Ⅳ期3例(4.9%),NREWⅢ-Ⅳ期6例(9.9%),REM期未见。结论VEEG检测有利于癫的诊断和确定临床发作分型,睡眠监测有助于样波的检出,睡眠期样放电主要出现于NREMⅠ-Ⅱ期。

Objective To explore the value of Video-EEG monitoring in the diagnosis and differential diagnosis and chlinical classification of epilepsy and the relationship between the sleep phase and the epileptiform discharges. Methods Video-EEG long-time monitoring under state of awaking and sleeping and evoked tests were performed in 93 patients withparoxysmal disorder. The nature of paroxysmal events and clinical classification were defined. We also analysed the distribution of interictal epileptiform discharges between wakeful and sleep phase. Results The characteristic events were captured in 51 of 93 patients. Epileptiform discharges were observed at 72 patients. Seizure types were defined in 69 of 93 patients with epilepsy and 20 seizure types were amended. In 71 cases, 65 patients had complete wake and sleep cycle. Interietal epileptiform discharges were found in 49 of 65 patients with epilepsy during wakefulness and in 61 of 65 patients with epilepsy during sleep, including 52 cases （85.2%） in stages Ⅰ-Ⅱ sleep, 3 cases （4. 9%） in stages Ⅰ-Ⅳ sleep and 6 cases （9. 9 %） in stages Ⅲ-Ⅳ, no one in REM sleep. Conclusions VEEG monitoring minght be helpful in the diagnosis and classification of epilepsy. Sleepness monitoring in epileptic patients could help to enhance the detection rate of epileptiform discharges. The epileptiform discharges were mainly found in the Ⅰ- Ⅱ stages of NREM sleep.