视频脑电图对重症病毒性脑炎非惊厥性癫痫持续状态的诊断及治疗价值

Diagnosis and treatment value of video electroencephalogram on non-convulsive status epilepticus of severe viral encephalitis

目的探讨视频脑电图(VEEG)在重症病毒性脑炎并发非惊厥性癫痫持续状态(NCSE)患者中的诊断及治疗意义。方法回顾性分析诊断的32例重型病毒性脑炎患者的临床症状、脑脊液、影像学资料、常规脑电图(REEG)及VEEG结果。结果 REEG检出异常率93.7%,VEEG检出异常率100%,两者相比较差异无统计学意义(P>0.05),其中REEG显示正常2例,轻度异常4例,中度异常19例,重度异常7例。VEEG显示中度异常18例,重度异常14例。REEG重度异常率21.9%,VEEG重度异常率43.75%,VEEG在检出重度异常脑电图显著优于REEG(P<0.05),且检出癫痫样放电发生率明显优于REEG,其中重度异常患者中发现8例为非惊厥性癫痫持续状态,8例患者经地西泮诊断性治疗后意识均有所恢复,癫痫样放电减少或消失。结论 VEEG在重症病毒性脑炎并发非惊厥性癫痫持续状态的诊断上有重要意义,可作为药物治疗后疗效观察。

Objective To investigate the value of Video Electroencephalogram on the diagnosis and treatment of severe viral en- cephalitis complicated with non convulsive status epilepticus （NCSE）. Methods 32 patients of severe viral encephalitis, analysis their clinical symptoms,cerebrospinal,imaging data, the results of REEG and VEEG were retrospectively analyzed. Results The abnormal rate of REEG was 93.7% ,the abnormal rate of VEEG was 100%, compared with REEG had no statistical difference （P 〉 0.05 ）. REEG showed 2 cases were normal,4 cases were mildly abnormal, 19 cases were moderately abnormal,7 cases were severe abnormal. VEEG showed that 18 cases were moderate abnormal, 14 cases were severely abnormal. The rate of severely abnormal was 21.9% in REEG,the rate of severely abnormal was 43.75% in VEEG, the detection rate of VEEG was significantly superior to REEG in severely abnormal EEG （P 〈 0.05） ,the detection rate of epileptiform discharges in VEEG was significantly higher than REEG. In severely abnormal pa- tients,8 cases were non convulsive status epilepticus, 8 cases patients received intravenous diazepam injection, patients consciousness were improved,epileptiform discharges were reduced or disappeared. Conclusion VEEG has significant value in diagnosis of severe viral encephalitis complicated with non convulsive status epilepticus, and it is used as clinical observation after drug treatment.