动态脑电图监测对癫痫停药后复发的预测价值

The predictive value of ambulatory electroencephalography in monitoring the recurrence of epilepsy after medication withdrawal

目的探讨动态脑电图(AEEG)监测对癫痫停药后复发的预测价值。方法对265例癫痫发作控制3年以上、AEEG正常后开始停药的患者进行5年的随访,每年至少行1次AEEG检查。分析停药患者初诊时、治疗过程中及停药前后的AEEG变化,探讨癫痫控制停药后复发与停药前后AEEG变化的可能关系。结果47例患者临床复发。初诊时、治疗过程中AEEG始终正常者复发率低,为8.1%:而AEEG出现痫样放电者复发率为25.0%,尤以出现局灶性颞、额、顶、枕区癫痫波和多灶性癫痫波者复发率高。停药后AEEG随访中脑电图重新出现癫痫波者,临床复发率也高。结论AEEG改变是癫痫是否复发的重要依据之一,AEEG监测对癫痫停药后的复发有一定的预测价值。

Objective To investigate the predictive value of ambulatory electroencephalography （AEEG） in monitoring the recurrence of epilepsy after medication withdrawal. Methods A five-year follow-up study was performed in 265 cases, antiepileptic drugs of whom were withdrawn after the onsets of epilepsy had been controlled thoroughly for over three years and the AEEGs had become normal; the AEEG examination was performed at least once per year for each patient. Alterations in AEEGs of the cases with medication withdrawn at the first visit, during the treatment, and before and after medication withdrawal were analyzed to find out the possible links between recurrences of epilepsy after withdrawal and AEEGs alterations before and after withdrawal. Results A total of 47 cases recurred clinically in the study. The cases with normal AEEGs at the first and during the treatment had a relatively low recurrence rate, 8.1%, but the cases with epileptiform AEEG discharges had a recurrence rate of 25.0% , especially high for those with epileptic waves in the focal temporal, frontal, parietal or occipital lobes, or multiple loci. Moreover, the clinical recurrence rates were also high in cases with epileptic waves reoccurred in EEGs during AEEG follow-up study after medication withdrawal. Conclusion The alteration in the AEEG is one of the significant clues for the determination of the recurrence of epilepsy and it has certain predictive value in monitoring the recurrence of epilepsy after medication withdrawal.