婴儿癫癎发作特征的录像脑电图分析

The ictal video-EEG symptomatology in infants with epilepsy

目的 分析婴儿癫发作的录像脑电图 (Video EEG)特征。方法 根据癫发作分类法对 45例婴儿 10 6次癫发作的Video EEG资料进行分析。结果 (1)全身性发作包括 :①全身性粗大肌阵挛 8例 32次发作 ,发作期EEG为阵发性全导棘慢波、多棘慢波或弥漫性低电压 ,肌阵挛与EEG相关性良好 ;②散发游走性肌阵挛 3例 ,面部及肢体远端频发间断肌阵挛 ,EEG为广泛持续慢波及多灶性棘波、尖波 ,肌阵挛与EEG无相关性 ;③婴儿痉挛 10例 17次发作 ,背景EEG为高峰节律紊乱 ,发作期为高波幅爆发和 (或 )低波幅抑制。全身性发作中缺乏完整的全身强直 阵挛性发作及失神发作。(2 )部分性发作 16例 42次发作 ,突出表现为无动性凝视 ,其次为简单自动症、植物神经症状及轻微的惊厥性症状。多数意识状态难以准确判断。EEG提示发作起源于额区、中央区、颞区或枕区。部分性继发全身性发作 5例 7次发作 ,EEG提示阵发性放电分别起源于颞区 2例 ,枕区 2例及多灶性 1例。(3)不能分类的发作 3例 5次发作 ,Video EEG主要表现为在 1次发作中出现多种发作类型。结论婴儿期癫发作在识别和分类上都比较困难。Video EEG监测同步分析有助于对婴儿癫发作的准确观察与分类。

Objective The manifestations of epileptic seizures in infancy usually are atypical and may cause a misdiagnosis. The authors analyzed the ictal clinical and EEG characteristics in infants with epilepsy in order to utilize the epileptic classification in clinical practice. Methods Pictures and EEG trails of video EEG recordings were analyzed synchronously in 45 infants with 106 times epilepstic seizures. Results Generalized seizures included: (1) the generalized massive myoclonus in 8 babies with 32 seizures, the ictal EEG showed generalized spike and waves, polyspike waves or diffused sudden suppression of the background activity for several seconds. The myoclonus showed a well correlation with EEG discharges. (2) fragmentary or erratic myoclonic seizures in 3 babies which had frequently disconnected myoclonic jerks in face regions and proximal limbs with continuance diffused slow waves and multi focal spikes and sharps. There was no correlation between myoclonus and EEG discharges. (3) infantile spasms in 10 cases with 17 seizures, which showed hypsarrhythmia in background EEG, while high amplitude burst and / or low voltage suppression during seizures. There were no organizational generalized tonic clonic seizure and absence seizure in generalized seizures. In 42 partial seizures of 16 babies, the prominent manifestations were less or no motor with staring. Other seizure spectrum included simple automatisms, autonomic symptoms and mild convulsive seizures. It was difficult to exactly estimate the consciousness level in most infants. The origins of partial seizures were from frontal, central, temporal or occipital areas. Seven partial seizures in 5 babies had secondary generalized convulsions. EEG might provide clues to origins of seizures. Five unclassified seizures in 3 babies were associated with transitional patterns of age depended seizure types. Conclusion Epileptic seizures in infancy were much different from elder children and adults. Atypical seizure manifestations of infants related closely to the immature development of the central nervous system and the impairments of brain structures and functions. Video EEG monitoring is helpful to the observation and classification of the seizures in infants with epilepsy. Pediatricians should pay attention to the seizure characteristics relating to the neurodevelopment when the international classification of epileptic seizures is applied in epilepsies of infancy.