脑电图动态监测对颅脑外伤后癫痫的诊断价值

Diagnostic value of ambulatory electroencephalography monitoring for post-traumatic epilepsy

目的探究脑电图动态监测对颅脑外伤后癫痫的诊断价值。方法选择中重度脑外伤患者132例，均在入院24 h内进行动态脑电图检查，并于外伤后6个月、1年及2年复查脑电图，随访2年。分析外伤后癫痫的发生和控制情况与脑电图之间的关系。结果根据时间段分析，132例患者中脑外伤后24 h内脑电图结果显示存在癫痫波18例，而6个月内发作癫痫34例，差异未见统计学意义（χ^2=1.88，P〉0.05）；脑外伤后6个月动态脑电图显示存在癫痫波22例，伤后6个月-1年内出现癫痫发作23例，差异有统计学意义（χ^2=87.2，P〈0.001）；脑外伤后1年脑电图显示存在癫痫波28例，伤后1-2年内出现癫痫发作26例，差异有统计学意义（χ^2=52.1，P〈0.001）。根据癫痫类型分析，132例患者中共出现外伤后癫痫41例，其中即刻癫痫2例，早期癫痫6例，晚期癫痫33例。对于即刻癫痫及早期癫痫，外伤后24 h内的脑电图检测灵敏度为75%，特异度为89%；对于晚期癫痫，在伤后6个月内、6个月-1年、1-2年时间段内，脑电图诊断癫痫再发的灵敏度为13%、82%、67%，特异度为72%、97%、90%。结论对于中重度颅脑损伤患者，脑电图的动态监测对于颅脑外伤后癫痫在6个月-1年、1-2年这两个时间段的发作具有较高的诊断价值；脑外伤后24 h内的脑电图监测对预测即刻癫痫及早期癫痫的发生有较高的诊断价值，而脑外伤后6个月、1年脑电图监测对于晚期癫痫发作的风险具有较高的诊断价值。

Objective To study the diagnostic value of ambulatory electroencephalography （AEEG） monitoring for post-traumatic epilepsy.Methods A total of 132 patients with moderate or severe cerebral trauma were selected and checked by AEEG within 24 h after admission, and were rechecked 6 months, 1 year and 2 years after trauma. All the patients were followed up for 2 years. The relationship of the development and control of post-traumatic epilepsy with AEEG was analyzed.Results According to time analysis, in all the 132 patients, results of AEEG within 24 h after trauma showed that there were 18 cases of epileptic wave; and 34 cases of epilepsy occurred within 6 months, the difference was not statistically significant （χ^2=1.88, P〉0.05）. In 6 months after traumatic brain injury, 22 cases had epilepsy wave according to AEEG, while 23 cases of epilepsy occurred in the period from 6 months to 1 year after trauma, the difference was statistically significant （χ^2=87.2, P〈0.001）. In 1 year after cerebral trauma, AEEG showed that there were 28 cases of epileptic waves, while 26 cases of epilepsy occurred in the period of 1-2 years after trauma, the difference was statistically significant （χ^2=52.1, P〈0.001）. According to the types of epilepsy, among the 132 patients, 41 patients had epilepsy after cerebral trauma, including 2 cases of immediate epilepsy, 6 cases of epilepsy in early stage and 33 cases of epilepsy in late stage. In the diagnosis of immediate epilepsy and early-stage epilepsy, the sensitivity of AEEG within 24 h after trauma was 75%, and the specificity was 89%; for the epilepsy in late stage, within 6 months, 6 months to 1 years, and 1-2 years after injury, the sensitivities of AEEG to recurrence of epilepsy were 13%, 82%, 67%, and the specificity was 72%, 97%, 90%, respectively.Conclusions For patients with moderate or severe cerebral trauma, AEEG has higher diagnostic value for post-traumatic epilepsy occurred in period of 6 months to 1 year and 1 year to 2 years. AEEG within 24 h has higher diagnostic value to predict immediate epilepsy and early-stage epilepsy. AEEG in 6 months and 1 year after trauma has high diagnostic value to predict epilepsy in late stage.