脑电趋势图监护在神经重症监护病房对癫痫及亚临床癫痫的诊断意义

Value of the trend overview during electroencephalographic monitoring in the diagnosis of clinical and subclinical seizures in neurological intensive care unit

目的通过连续和动态监护神经重症监护病房（N-ICU）患者的脑电图（EEG）变化，观察脑趋势网改变与癫痫的关系，探讨脑电趋势图对癫痫以及亚临床癫痫的诊断意义。方法N-ICU 15例癫痫患者，其中癫痫持续状态（SE）10例，予以脑电监护，采用10．20标准电极安装法，8导参考电极导联法（Fp1-A1、C3-A1、T3-A1、O1-A1、FD2-A2、C4-A2、T4-A2、O2-A2）采集脑电趋势图数据，包括振幅整合脑电图（aEEG）、样本包络、波段功率（BP）。对同一患者的癫痫发作期和间期的数值分别求出平均值，进行对比分析。采用ROC分析评价3种趋势图对癫痫诊断能力。结果癫痫在N—ICU的发生率为15／122。15例癫痫患者中癫痫持续状态（SE）10例，全面性惊厥性癫痫持续状态（GCSE）8例，非惊厥性癫痫持续状态（NCSE）7例，GCSE发作后继之NCSE5例。癫痫发作时aEEG上界和下界分别上升了27．90％和33．53％，形成一明显“波峰”，与未发作时比较，差异均有统计学意义（P〈0．05）。参考电极导联样本包络波幅上升了124．09％，与未发作时比较，差异有统计学意义（P〈0．05）。α和β波段的绝对波段功率（ABP）明显增高，与未发作时比较，差异均有统计学意义（P〈0．05）。结论癫痫及亚临床癫痫在N—ICU发生率较高，3种趋势图对癫痫发作的诊断都有价值，aEEG诊断能力强于样本包络，BP结果可提供参考。

Objective To explore the association between the trend ofelectroencephalographic （EEG） alterations and seizure （especially subclinical seizure） and assess the value of EEG trend overview obtained by continuous EEG monitoring in the diagnosis of clinical and subclinical seizures in the neurological intensive care unit （N-ICU）. Methods Fifteen epileptic patients including 10 with status epilepticus （SE） in the N-ICU were enrolled in this study. The EEG was monitored using the 10-20 electrode system with 8-channel referential derivations （Fp1-A1, C3-A1, T3-A1, O1-A1, Fp2-A2, C4-A2, T4-A2, and O2-A2） to record the amplitude integrated EEG （aEEG）, Envelope and band power （BP） trends. For each patient, the data collected during the seizure episodes and the seizure-free intervals were separately averaged for a comparative analysis. The diagnostic capabilities of the 3 EEG trends were estimated using the receiver-operating characteristic （ROC） curve. Results The total incidence of seizure in the N-ICU was 12.30% in the 15 patients, including 10 with SE （8.20%） and 7 with nonconvulsive SE （NCSE, 5.65%）. In 62.5% of the patients, the SE episode was followed by NCSE. During the seizure episode, the upper and lower bounds ofaEEG increased obviously by 27.9% （t=6.019, P〈0.05） and 33.53% （ t=5.438, P〈0.05）, respectively, as compared with those in the seizure-flee interval. In the seizure episodes, the wave amplitude of Envelope increased by 124.09% （t=3.229, P〈0.05） in the referential derivation, and the absolute band power （ABP） increased at all the bands with significant changes in α and β band powers （t=2.528 and t=2.627, respectively,（P〈0.05）. Conclusions Clinical and subclinical seizures occur in the N-ICU at high incidences, for which all the 3 EEG trends have diagnostic values, aEEG has a better diagnostic capability than Envelope, and the results of BP may offer references for the diagnosis.