不同类型癫痫的影像学及视频脑电图分析

Value of video electroencephalogram and brain imaging in diagnosis of epilepsy

目的探讨颅脑影像学检查和视频脑电图（VEEG）在不同类型癫痫病因诊断中的应用。方法对112例不同类型癫痫患者的常规脑电图（REEG）、VEEG、颅脑CT和MRI结果进行对比研究。结果112例患者中39例（34．8％）REEG发现异常放电，87例（77．7％）VEEG发现异常放电；颅脑MRI发现病灶70例（62．5％），颅脑CT发现病灶37例（33．0％）。局灶性放电和弥漫性放电患者颅脑MRI局灶性病变率比较差异有统计学意义[58．9％（43/73）比21．4％（3／14）]（P〈0．01）。颞叶异常放电和颞叶外异常放电定位符合率比较差异有统计学意义[53．1％（17/32）比26．8％（1l，41）]（P〈0．01）。结论VEEG异常放电的异常率明显比REEG高，颅脑MRI能较好地显示癫痫性放电病灶，是癫痫病灶定位诊断的重要手段，两者对于癫痫病灶的鉴定具有一定的相关关系。两种检查手段紧密结合对于不同类型癫痫的定位、定性诊断具有十分重要的意义。

Objective To analyze the value of video electroencephalogram （VEEG） and brain imaging in diagnosis of epilepsy. Methods The routine electroencephalogram （REEG）, VEEG, brain MRI and CT results of 112 patients with epilepsy were compared. Results In 112 epilepsy patients,39 patients （34.8%） showed epileptic focus in REEG,and 87 patients （77.7%） showed epileptic focus in VEEG. Seventy patients （62.5%） revealed lesions by brain MRI examination, 37 patients （33.0%） revealed lesions by brain CT examination. Focal abnormal rate of brain MRI examination had significant difference between focal discharge patients and diffuse discharge patients [58.9%（43/73） vs. 21.4%（3/14）] （P 〈0.01）. Positioning accuracy had significant difference between temporal lobe discharge and outside temporal lobe discharge [ 53.1% （ 17/32 ） vs. 26.8% （ 11/41 ） ] （P 〈 0.01 ）. Conclusions Rate of epileptic discharge found by VEEG is significantly higher than that by REEG. Brain MRI displays epileptic discharge lesions better than brain CT, and MRI is an important method to find epileptic focus localization. It has a certain relationship between these two methods. It has a very important significance to combine with both methods in diagnosis of epilepsy.