癫痫持续状态的临床及脑电图特征

Clinical characteristics and electroencephalogram pattern of status epilepticus

目的探讨癫痫持续状态的脑电图特征及临床特点。方法回顾性分析经抗癫痫药物治疗的5例癫痫持续状态的临床资料,总结发作症状学、头皮脑电图及颅内MRI特点,研究癫痫再发的脑电图特点、诱发因素及其治疗方法。结果 5例患者中1例自行停服抗癫痫药物诱发,1例患者无明显诱因自发发作,1例患者由肺部感染后诱发,2例疲劳或睡眠不足、情绪不良诱发。4例MRI发现结构性病变。4例脑电图(EEG)显示多灶性或局灶性癫痫样放电,其中1例癫痫持续状态发作前有与颅内MRI结构性病变一致的尖波节律暴发,1例局灶性慢波活动。结论多数癫痫持续状态患者存在脑的结构性损害,大多有明显的诱发因素,阵发性尖波节律暴发可能是预测癫痫持续状态发作的脑电图特点,长程视频脑电图应成为癫痫持续状态诊疗的必用工具,尤其是对于非惊厥性癫痫持续状态更具有重要的意义,持续静脉泵入咪达唑仑治疗癫痫持续状态安全、有效且不良反应少。

Objective To study the clinical, scalp electroencephalogram （EEG） characteristics of status epilepticus （SE）. Methods The clinical data of 5 patients of status epilepticus who were treated in our hospital were reviewed retrospectively. Their scalp EEG and MRI were investigated. Results All of the patients were diagnosed as SE, and most of seizures were provoked by obvious factors, 1 of them were provoked by AEDs withdrawal,lof them didn＇t any cause of SE,1 of them were provoked by lung infectiun,2 of them were induced by tiredness and sleeping insufficiency, and bad mood. MRI showed extensive lesions in 4 cases. Scalp EEG showed mtdifocality or focal epilepsic discharge in 4 cases, 1 of them showed sharp rhythm before SE, 1 of them showed slow wave activity. Conclusions Most of the patients with SE have brain lesions, and most of seizures are provoked by obvious factors. EEG spike rhythm may be a predictive biomarker for the development of SE, continuous VEEG monitoring appears to be a essential tool for diagnosis and treatment of SE. Midazolan is effective and safe in the treatment of SE.