视频脑电图在小儿非癫痫发作诊断中的价值

Value of video-electroencephalography for the diagnosis of children with non-epileptic seizures

目的探讨视频脑电图（VEEG）在小儿非癫痫发作（NES）诊断中的应用价值。方法回顾性分析280例NES患儿的临床资料，所有患儿均进行常规脑电图（EEG）、VEEG、头颅CT和MRI检查。结果常规EEG上发作期见到正常脑电波183例，异常脑电波97例；VEEG正常207例（73．9％，207~80），异常73例（26．1％，73/280）。躯体性NES患儿210例（75．0％，210／280），心因性NES患儿70例（25．0％，70／280），NES合并癫痫者22例，其中MRI检查发现病灶20例（90．9％，20／22），头颅CT检查发现病灶14例（63．6％，14／22），对于合并性诊断，MRI的病灶检出率高于CT，差异有统计学意义（P〈0．05）。结论VEEG是诊断儿童NES的重要手段，同时也是与癫痫发作进行鉴别的有效客观检查方法。结合头颅影像学检查更能进一步提高与癫痫异常放电的鉴别，并可进一步显示癫痫样放电病灶的有关结构特征，是癫痫病因诊断重要的定性手段。

Objective To study the value of video-electroencephalography（VEEG） for the diagnosis of children with non-epileptic seizures （NES）. Methods A retrospective analysis was carried out in 280 patients with NES diagnosed by VEEG surveillance. All the patients underwent routine electroencephalography （EEG）, VEEG, CT and MRI examination. Results Routine EEG was normal in 183 cases, and abnormal in 97 cases. VEEG recording was normal in 207 cases （73.9%, 207/280）, and abnormal in 73 cases （26.1%, 73/280）. The somatic NES was in 210 cases （75.00/0,210/280）, and psychogenic NES was in 70 cases （25.0%,70/280）. NES combined with epilepsy were in 22 cases＇, MRI found 20 cases （90.9%,20/22） and head CT found 14 cases （63.6%, 14/22）. In the combined diagnosis, MRI was higher than CT in detecting focus （P 〈 0.05）. Conclusions VEEG is the important means of diagnosing children with NES, which is also important to differentiate with epilepsy. Combined with cranial imaging studies, it improves the identification of abnormal discharge and epilepsy, and further reveals the structural features of the epileptic discharge lesions is an important qualitative means of epilepsy etiological diagnosis.