长程视频脑电图监测癫痫患者发作间期痫样放电的时段分析

Monitoring time of interictal epileptiform discharges by long-term video EEG in patients with epilepsy

目的:优化长程视频脑电图(VEEG)对癫痫患者发作间期痫样放电(IED)的监测时段。方法:回顾性分析了346例(349例次)不同就诊目的、不同清醒睡眠状态、不同MRI检查结果的癫痫患者采用VEEG在不同时段检出IED的累计百分率。其中明确诊断就诊164例(165例次),癫痫术前评估124例(124例次),调整抗癫痫药物治疗方案58例(60例次);MRI有确定或很可能的责任病灶98例(98例次),MRI无特异性变化和无异常发现173例(174例次)。结果:在346例(349例次)患者中231例次在24 h内记录到IED,以明确诊断或调整药物为就诊目的的患者记录到IED的比例均低于术前评估的患者。24 h内记录到IED的累计百分率在8 h内逐渐增至59.0%,随后趋向稳定;46.8%的癫痫患者记录到IED包括睡眠状态,并主要发生在非快速眼动睡眠Ⅱ期;MRI异常患者在各时间段出现IED的累计百分率均最高,8 h达到83.7%,之后趋向稳定。结论:一段至少包括浅睡期的8 h VEEG对于记录到IED可能是足够的,IED更容易在难治性癫痫和MRI有异常的患者中记录到。

Objective:To optimize the monitoring time of interictal epileptiform discharges(IED) in patients with epilepsy by long-term video electroencephalogram(VEEG).Methods;The cumulative percentages of IED detected by VEEG in 346 epilepsy patients(349 times) with different purposes,different waking sleep states and different MRI findings were retrospectively analyzed.According to the purposes,there were 164 patients(165 times) for clarifying diagnosis,124 patients(124 times) for preoperative evaluation and 58 patients(60 times) for adjustment of medications.According to MRI results,there were responsible lesions in 98 patients(98 times) and no responsible lesions in 173 patients(174 times).Results;Among 346 patients(349 times),IED was detected within 24 h in 231 patients(times).The percentage of detection in patients with purpose of preoperative evaluation was higher than those with purpose of diagnosis and medication adjustment.The detection of LED was gradually increased in first 8 h with 59.0%,then stably in 24 h.46.8% IED was recorded during sleep time,particularly in the second stage of sleep.The cumulative percentage of IED in patients with abnormal MRI findings was higher in all periods.It reached 83.7% within 8 h,and then tended to be stable.Conclusion;The study shows that LED should be monitored by VEEG at least 8 hours and should include the second stage of sleep in patients with epilepsy.Patients with refractory epilepsy and with abnormal lesions on MRI should record IED more frequently.