额颞叶癫痫临床下发作的脑电图分析

EEG analysis of subclinical seizures in frontotemporal lobe epilepsy

目的 分析额颞叶起源癫痫临床下发作的脑电图特点及临床意义。方法 收集2020年1月—2021年1月就诊于天津医科大学总医院神经内科门诊及住院的通过24小时视频脑电图监测存在临床下发作的癫痫患者,分析脑电图在发作持续时间、发作次数、发作时间(睡眠期/清醒期)、发作间期放电、发作累及导联数方面的特点及临床意义。结果 共纳入18例患者,捕捉到临床下发作280次(11/18)、临床发作34次(9/18),其中2例患者同时存在临床下发作及临床发作。额叶起源:临床下发作235次、临床发作15次;颞叶起源:临床下发作26次、临床发作19次;额颞叶起源:临床下发作19次、未捕捉到临床发作。临床下发作组中(11/18):睡眠期发作163次(58.2%)、清醒期发作117次(41.8%);临床发作组中(9/18):睡眠期发作16次(47.1%)、清醒期发作18次(52.9%)。在发作累及导联数中:<6个导联,临床下发作270次、未发现临床发作;≥6个导联,临床下发作10次、临床发作34次。在总癫痫发作持续时间中:临床发作组为(27.43±17.73)s,中位数值30 s;临床下发作组为(20.10±15.68)s,中位数值13 s。Spearman相关因素分析显示,临床下发作组与睡眠期(P=0.000)呈正相关,与核磁共振成像正常呈负相关(P=0.004)。结论 额颞叶起源的癫痫在临床下发作中有发作持续时间短,累及导联数少,睡眠期更易发生,且核磁共振成像异常的更易出现临床下发作的特点。因此,加强对癫痫患者长程视频脑电图监测,重视睡眠期脑电图的判读,有助于发现患者的临床下发作,进一步完善癫痫患者的管理。

Objective To analyze the EEG characteristics and clinical significance of subclinical epilepsy from frontotemporal lobe.Methods A collection of patients with epilepsy who had subclinical seizures monitored by 24-hour video EEG from January 2020 to January 2021 in the Neurology Department of General Hospital of Tianjin Medical University General Hospital,and analyzed the duration of seizures and the number of seizures on the EEG.The characteristics and clinical significance of onset time(sleep period/waking period),interictal discharge,and number of leads involved in seizures.Results A total of 18 patients were enrolled,and 280 clinical seizures(11/18) and 34 clinical seizures(9/18) were captured.Among them,2 patients had both subclinical seizures and clinical seizures.Frontal lobe origin,235 subclinical seizures and 15 clinical seizures;temporal lobe origin,26 subclinical seizures and 19 clinical seizures;frontotemporal lobe origin,subclinical seizures 19 times,no clinical seizures were captured.In the subclinical seizure group(11/18),there were 163 sleep episodes(58.2%) and 117(41.8%) during waking phase;in the clinical seizure group(9/18),16 episodes during sleep(47.1%),18 seizures(52.9%) in the awake period.Among the leads involved in seizures,<6 leads,270 subclinical seizures,and no clinical seizures;≥6 leads,subclinical seizures 10 times,and 34 clinical seizures.In the total duration of seizures:the clinical seizure group was(27.43±17.73) s,with a median value of 30s;the subclinical seizure group was(20.10±15.68) s,with a median value of 13 s.In the analysis of Spearman related factors,the subclinical seizure group was positively correlated with the sleep period(P=0.000),and negatively correlated with the normal nuclear magnetic field(P=0.004).Conclusion The epilepsy originated from the frontotemporal lobe has the characteristics of short clinical seizures,fewer leads involved,more likely to occur during sleep,and subclinical seizures that are more likely to occur when the MRI is abnormal.Therefore,strengthening the monitoring of long-term video EEG for patients with epilepsy and attaching importance to the interpretation of EEG during sleep will help to detect the subclinical seizures of patients and further improve the management of patients with epilepsy.