睡眠相关过度运动癫的临床及脑电图特征分析

Clinical and electroencephalographic features of sleep-related hypermotor epilepsy

目的探讨睡眠相关过度运动癫之临床特征并评价头皮视频脑电图(VEEG)的诊断价值。方法对2014年5月至2020年1月确诊的32例睡眠相关过度运动癫病例进行回顾,分析其一般临床资料、发作期症状学、发作间期及发作期脑电图模式。结果10例(31.25%)患者MRI呈异常征象。依据发作症状学模式(SPs)分类,SP1(早期的初级运动表现)1例(3.13%)、SP2(不自然的过度运动)18例(56.25%)、SP3(协调的过度运动)6例(18.75%)、SP4(富有情感内容的姿势行为)7例(21.88%)。发作间期及发作期脑电图异常率分别为81.25%(26/32)和71.88%(23/32);其中发作期头皮脑电图起始早于临床症状者23例(71.88%),放电部位局灶性14例(43.75%)、脑区性8例(25%),两种起始模式以包含各种低波幅快活动者为主;双侧性/广泛性1例(3.13%)。11例(34.38%)患者发作间期样放电部位与发作期脑电图所示起始部位相符且恒定局限于1个或相邻23个电极。结论睡眠相关过度运动癫影像学阳性检出率较低,症状学具有特殊性,高质量视频脑电图记录及判读在诊断与管理中具有重要地位,发作期脑电图可为术前评估提供必要的定侧及定位信息。

Objective To investigate clinical characteristics and diagnostic value of scalp videoelectroencephalography(VEEG)for sleep-related hypermotor epilepsy(SHE).Methods Total 32 patientswith SHE from May 2014 to January 2020 were collected,and their general clinical data,clinicalsemiology,interictal electroencephalography(EEG)and onset patterns of ictal EEG were analyzed.Results Ten patients(31.25%)showed abnormal signs on MRI.Patients were categorized according to theirsemiology patterns(SPs).One patient(3.13%)was classified as SP1(elementary motor signs),18 patients(56.25%)as SP2(unnatural hypermotor movements),6 patients(18.75%)as SP3(integrated hypermotormovements),and 7 patients(21.88%)as SP4(gestural behaviors with high emotional content).The positivefinding in interictal and ictal EEG were seen in 81.25%(26/32)and 71.88%(23/32)of patients.EEGonset occured earlier than clinical seizure in 23 patients(71.88%).Among these 23 patients whose scalpEEG started earlier than clinical seizure,14 patients(43.75%)had focal discharge,8 patients(25%)hadregional discharge,one patient(3.13%)had bilateral/extensive discharge.Among initial scalp EEG patternswith focal and regional discharge,low-voltage fast activity was the most common.In addition,11 patients(34.38%)had EEG epileptiform discharges at the same brain region during the interictal and ictal EEGrecording,which were constantly confined to 1 or 2 to 3 adjacent electrodes.Conclusions sThe rate ofpositive finding in imaging in patients with SHE is low.However,the symptomatic manifestations arespecific.High-quality VEEG recording and interpretation play an important role in the diagnosis andmanagement of SHE patients.Ictal EEG can provide the necessary lateralization and localizationinformation for preoperative evaluation.