75例额叶癫痫的临床特点及发作期发作间期脑电图分析

The analysis of clinical features and characteristics of interictal and ictal EEG in 75 cases with frontal lobe of epilepsy

目的回顾性分析额叶癫痫(FLE)的临床及发作期和发作间期脑电图特点,为临床早期识别和治疗提供依据。方法详细整理75例FLE患者的临床资料,发作期及发作间期脑电图改变和影像学表现,并进行总结分析。结果 (1)临床表现:一种发作类型25例(33%);两种或两种以上发作类型50例(67%);发作时意识清醒者20例(27%);丛集性发作27例(36%);夜间发作36例(48%)。(2)脑电图表现:1发作间期脑电:50例FLE行长程视频脑电监测中异常者47例(94%);2发作期脑电:监测到临床发作22例;3睡眠期痫性放电阳性率高于清醒期(P<0.01)。(3)影像学表现:影像学检查异常且病灶位于额叶者36例(54%);非额叶病灶者5例(7.6%);神经影像学未见异常者25例(33%)。结论 FLE临床表现复杂多样,运动症状常见;意识恢复快,多无发作后状态;FLE多于夜间发作,发作时间短暂,呈丛集性发作;FLE脑电图特异性差,长程视频脑电较普通脑电易于检测出痫性放电,睡眠期脑电图阳性率高于清醒期;FLE脑电显示多无侧别提示。

Objective To analyse the clinical manifestations,EEG characteristics retrospectively and provide clinical basis for early diagnosis and prompt treatment. Methods The clinical data,ictal and interictal EEG and imaging manifestations of the 75 FLE patients were analysed in detail. Results（ 1） Clinical manifestations： 25 cases of single attack type,（ n= 33%）,50 cases of two kinds or more than two kinds of seizure types（ n = 57%）; 20 cases of attack of conscious,（ n =27%）; 27 cases of cluster seizures（ n = 36%）; 36 cases of nocturnal seizures,（ n = 48%）.（ 2） EEG： 1Interictal EEG monitoring results： In 50 cases with FLE of VEEG,47 cases were abnormal（ n = 94%）; 2Onset EEG monitoring results： 22 cases of clinicalseizures were detected; 3The rate of sleep of epileptic discharge was higher than that of sober of epileptic discharge（ P 〈0. 01）.（ 3） Imaging findings： 36 cases of image anomalies and lesions in frontal lobe（ n = 54%）; 5 cases of non-frontal lobe lesions（ n = 7. 6%）; 25 cases of normal results（ n = 33%）. Conclusion The clinical manifestations of FLE are complex and diverse and the motor symptoms are common; consciousness after the onset is rapidly recovered in FLE; Frontal lobe epilepsy easily tends to attack at night and the duration of attack is short and is easy to cluster seizures;the specificity of EEG of FLE is poor,long-term video EEG as compared with scalp EEG is easy to detect the discharge,and the positive rate of sleep period is higher than in the awake period; EEG results of FLE show no side tips.