持续时间短暂癫痫发作临床及神经电生理研究

The clinical and neuro-electrophysiological study of transient epileptic seizures in children

目的应用视频脑电图(VEEG)-肌电图(EMG)多导监测技术探索几种持续时间短暂的癫痫发作临床及神经电生理鉴别要点。方法对北京大学第一医院小儿神经科2012年6月至2013年3月期间VEEG监测到的以快速跌倒、点头或肢体抖动为主要发作表现的51例癫痫患儿进行回顾性研究,分析每次发作时临床、脑电图(EEG)和EMG特点及相互关系。结果 51例共监测到745次临床发作,包括癫痫性痉挛发作391次(52.5%)、肌阵挛发作138次(18.5%)、失张力发作117次(15.7%)、负性肌阵挛61次(8.2%)、强直发作27次(3.6%)、肌阵挛-失张力发作11次(1.5%)。不同发作形式具有各自的临床-脑电-肌电特征。依据发作期EMG,可大致分为肌电爆发和肌电静息(衰减)组。结论以快速跌倒、点头或肢体抖动为特征的癫痫发作最常见于癫痫性痉挛、肌阵挛发作、强直发作、失张力发作、负性肌阵挛、肌阵挛-失张力,其共同特点是快速而短暂,单纯根据病史描述难以准确区分。应用VEEG-EMG多导监测技术可对其发作形式进行准确分类,从而有助癫痫的诊断、分类和治疗。

Objective To study the clinical and neuro-electrophysiological features of transient epileptic seizures by using polygraphic channel VEEG-EMG monitoring. Methods The information of 51 epilepsy children with rapid falling, nodding or limb shaking in video electroencephalogram was collected in the Department of Pediatric Neurology, Peking University First Hospital from June 2012 to March 2013.The clinical features, EEG and EMG patterns were analyzed retrospectively. Results Totally 745 seizures were found in 51 patients. The seizures included 391 epileptic spasms （52.5%）, 138 myoclonic seizures （18.5%）, 117 atonic seizures （15.7%）, 61 negative myoclonus （8.2%）, 27 tonic seizures （3.6%）and 11 myoclonic atonic seizures （1.5%）.Different clinical manifestations were with different elinical-EEG-EMG patterns.According to the duration of EMG changes, patients were divided into EMG-burst group and EMG-statie group. Conclusions Epileptic seizures with rapid falling, nodding or limb shaking are most affected by epileptic spasms, myoclonic seizures, atonic seizures, negative myoclonus, tonic seizures and myoclonic atonic seizures. Their common feature is rapid and transient, which makes them difficult to be diagnosed only by illness history.But by performing VEEG-EMG, we can accurately identify the types of seizures, which will be helpfnl in the diagnosis and treatment.