儿童枕叶癫痫视觉诱发电位、事件相关电位P300、脑电图特点分析与临床应用

Characteristical analysis and clinical application of visual evoked potential,event-related potential P300 and electroencephalograph in childhood occipital epilepsy

目的探讨不同类型枕叶癫痫患儿视觉诱发电位(VEP)、事件相关电位P300及脑电图(EEG)放电指数的变化特点,为儿童枕叶癫痫的诊断提供依据。方法选取儿童枕叶癫痫患儿46例,其中特发性枕叶癫痫28例(特发组)、症状性枕叶癫痫18例(症状组);同期健康志愿儿童31例(对照组)。各组分别于治疗前、药物治疗1年(治疗后)行VEP、事件相关电位P300及EEG放电指数检测。结果与对照组比较,特发组VEP波幅明显升高(P=0.000),异常率为75%(21/28),VEP潜伏期、P300潜伏期及波幅均无统计学差异(P均>0.05);症状组VEP、P300波幅均无统计学差异(P均>0.05)),VEP潜伏期明显延长(P=0.000),异常率为100%(18/18),P300潜伏期延长(P=0.000),其中3例分化差,7例潜伏期明显延长,异常率为55.6%(10/18)。与治疗前比较,特发组治疗后VEP波幅、EEG放电指数均明显降低(P均=0.000),症状组VEP及P300潜伏期均明显缩短、EEG放电指数明显降低(P均=0.000)。特发组EEG放电指数与VEP波幅呈正相关(r=0.635,P=0.000),与P300潜伏期无相关性(r=0.208,P=0.289);症状组EEG放电指数与VEP、P300潜伏期均呈正相关性(r分别为0.489、0.878,P均<0.05)。结论儿童枕叶癫痫VEP、P300与EEG放电指数之间存在明显的相关性,三者可共同作为鉴别诊断及监测治疗效果的客观评价指标。

Objective To explore the characteristics of visual evoked potential（ VEP）,event-related potential P300 and electroencephalograph（ EEG） discharge indexes in childhood occipital epilepsy,and to provide basis for diagnosis of occipital epilepsy. Methods Forty-six children with childhood occipital epilepsy,including 28 cases of idiopathic childhood occipital epilepsy（ ICOE group） and 18 cases of symptomatic childhood occipital epilepsy（ SCOE group） were selected,as well as 31 cases of healthy subjects（ control group）. The discharge indexes of VEP,P300 and EEG before and after one year treatment were detected. Results Compared with the control group,the VEP amplitude of the ICOE group rose significantly（ P = 0. 000）,the abnormal rate was 75%（ 21 /28）,while the VEP latency,the P300 latency and amplitude had no statistical difference（ all P〉0. 05）; no difference was found in the VEP and P300 amplitude of the SCOE group（ P〈0. 05）,while the VEP latency was prolonged（ P = 0. 000）,the abnormal rate was 100%（ 18 /18）,and the latency of P300 was prolonged（ P = 0. 000）,3 out of 18 cases were poorly differentiated,and the latency of 7 cases was prolonged（ 10 /18,55. 6%）. After treatment,the VEP amplitude and EEG discharge index of the ICOE group was significantly reduced（ P = 0. 000）,the VEP,P300 latency and EEG discharge index of the SCOE was reduced（ P = 0. 000）. In the ICOE group,there was a positive correlation between EEG discharge index and VEP amplitude（ r = 0. 635,P = 0. 000）,there was no correlation between EEG discharge index and P300 latency（ r = 0. 208,P = 0. 289）. In the SCOE group,EEG discharge index was positively correlated with VEP,P300 latency（ r = 0. 489,0. 878,respectively; all P〈0. 05）.Conclusions There are significant correlations between EEG,VEP and P300 discharge indexes,and they all can work to-gether as the objective evaluation for the differential diagnosis and antiepileptic drug efficacy.