发作间期癎样放电对致癎区定位的诊断意义

Location significance of epileptogenic zone interictal in epileptiform discharge

目的：通过受试者工作特征曲线（ROC曲线）来评估发作间期癎样放电在清醒睡眠周期的各期中定位作用的差异，以为癫癎的临床定位提供参考。方法：收集三博脑科医院的癫癎患者34例，并分为颞叶癫癎组和对照组。按入选标准选择的24h脑电图分为清醒、NREMI－Ⅱ期、NREMⅢ－IV、REM四种时段。使用ROC曲线定量地评价各个时段发作间期癎样放电对致癎灶的定位价值，并用ROC曲线求各个时段的最佳诊断界值点。结果：去除各个时段中无发作间期癎样放电的病例之后，以上四个时段，ROC曲线下面积差异均有统计学意义。并且用ROC曲线完成了最佳诊断点的估计。结论：依据清醒期的癎样放电定位诊断准确性较高，依据REM期的癎样放电定位诊断准确性达到理想，NREMI－Ⅱ期和NREMIII—IV期的癎样放电具有比较好的诊断意义。可以用ROC曲线来估计最佳诊断点。

Objective： To evaluate the effect of location of interictal epileptiform discharge （IID） during circadian rhythm using Receiver operator characteristic （ROC） curves. Methods：Thirty--four patients were diagnosed with epilepsy at Sanbo Brain Hospital from January 2011 to December 2011. Patients were divided into the temporal lobe epilepsy group and the control group. EEG data were divided into four time periods： waking, NREM I --II , NREM Ill-IV, and REM. Results：After exclusion of patients without liD, areas under the ROC curves （AUCs） of waking, NREM I --II , NREM HI -IV, and REM were 0. 992, 0. 799, 0. 786, and 1.0, respectively; P value of the AUCs was less than 0.05. Based on the ROC curves and the Youden index, the optimal operating points （OOPs） of REM, NREM I -II , NREM III--IV, and waking, were approximately 40%, 40%, 30%, and 20%, respectively. These results showed that ROC curves could be used to evaluate OOPs. Conclusion： Based on the ROC curves, the order of diagnosis accuracy that could be achieved during the time periods in this study is REM 〈 waking 〈NREM I -- II , NREM III -- IV. The criteria for OOPs can be interchanged according to clinical requirements.