额叶癫痫的长程视频脑电特征及其在额叶癫痫诊断和外科定位中的应用

Characteristics of long-term video electroencephalogram of frontal epilepsy and its application to epiletic diagnosis and preoperative localization of the epileptogenic foci

目的探讨长程视频脑电(VEEG)在额叶癫痫诊断及手术定位中应用的意义。方法回顾性分析47例诊断为额叶性癫痫并进行手术治疗患者的长程视频脑电特征及临床资料。结果癫痫临床发作有以下特点:①持续时间短;②睡眠中较多见;③继发难治全身性发作多见;④强直性或运动性姿势症状突出;⑤常伴发声。癫痫发作间期VEEG存在以下形式:①脑电无异常;②一侧额部或一侧前头部异常波形波幅优势;③额部或前头部异常波形波幅优势且双侧对称;发作期VEEG存在以下形式:①多见去同步化低电压;②一侧或双侧额叶低幅快活动;③一侧或双侧额叶的高幅优势放电;④全导联同步对称异常放电。38例患者的癫痫灶术前被精确定位,9例患者癫痫灶术前不能确定侧别。结论应用长程视频脑电监测能够较全面了解额叶癫痫临床发作表现及脑电图特点,有助于准确诊断及术前定位。

Objective To investigate the characteristics of long-term video electroencephalogram （VEEG） of frontal epilepsy and its value to the diagnosis of frontal epilepsy and preoperative localization of the epileptogenic foci.Method The clinical data of 47 patients with intractable frontal epilepsy undergoing surgery,including the data of VEEG monitoring and so on,were analyzed retrospectively.Results The characteristics of clinical seizures in these 47 patients with intractable frontal epilepsy were as follows： ① the seizure lasted short time;②The seizure was more common at night than that in daytime;③ The secondary systemic seizure was common.④Tonic or gesticulatory seizure was obvious.⑤ The seizure was often accompanied with phonation.The characteristics of the interictal VEEG in these 47 patients included normal VEEG,the preponderant abnormal waves in one side of frontal lobe or the front of head and preponderant and symmetrical abnormal waves in the double sides of frontal lobes or the front of head.The VEEG characteristics during the period of seizure in these 47 patients included desynchronization with low voltage,quick waves with low amplitude in one or double sides of frontal lobe epileptic discharge with high amplitude in one side or double sides of frontal lobes and synchronous and symmetrical epileptic discharge from all the electrodes.The epileptic foci were accurately localized by long-term VEEG in 38 patients and not in 9 ones.Conclusions The long term VEEG monitoring,by which the relationship between the characteristics of clinical seizure and EEG may be understood well in the patients with frontal epilepsy,is helpful to the accurate diagnosis of intractable frontal epilepsy and localization of the epileptogenic foci.