间断闪光刺激诱发试验在儿童视频脑电图中的应用分析

Analysis of intermittent photic stimulation in children′s video electroencephalography

目的探讨间断闪光刺激(IPS)诱发实验在儿童视频脑电图的应用价值。方法回顾性分析2021年3月至2022年3月重庆医科大学附属儿童医院两江院区1~18岁儿童青少年行视频脑电图检查并行IPS诱发实验的8994例患儿的临床资料,并将患儿分为非癫痫组和确诊或拟诊癫痫组,对其IPS反应、临床及脑电图特征进行分析。分类变量使用频数和百分数表示,IPS反应与年龄关系采用χ^(2)检验或Fisher′s确切概率法。结果8994例患儿,中位年龄6.3岁。非癫痫组患儿2310例(25.7%),其中男1364例(59.0%),女946例(41.0%);确诊或拟诊癫痫组患儿6684例(74.3%),其中男3842例(57.5%),女2842例(42.5%)。非癫痫组患儿IPS光驱动反应141例(6.1%),光阵发反应(PPR)1例;确诊或拟诊癫痫组患儿IPS光驱动反应160例(2.4%),PPR 82例(1.2%),光惊厥反应18例(0.3%),不对称光驱动反应14例(0.2%)。确诊或拟诊癫痫组患儿不同年龄、性别、癫痫放电及发作类型IPS光敏性反应存在差异,其中6~18岁组患儿的光敏性反应明显高于1~<6岁组(P<0.001),女性患儿是男性患儿的1.9倍,广泛性放电是局灶性放电的1.7倍,光惊厥全面性发作是局灶性发作的2.5倍。结论常规标准化IPS诱发实验对确诊或拟诊癫痫患儿的光敏性检出有重要意义,能有效指导临床医疗工作。

Objective To explore the value of intermittent photic stimulation(IPS)in children′s video electroencephalography(EEG).Methods The data of 8994 children aged 1 to 18 years,who received IPS in the video EEG examination at the Liangjiang Campus of the Children′s Hospital of Chongqing Medical University from March 2021 to March 2022,were analyzed retrospectively.Patients were divided into non-epilepsy group and confirmed or suspected epilepsy group.Their IPS responses,clinical and EEG characteristics were collected.Categorical variables were expressed using frequencies and percentages.The relationship between IPS response and age was determined by Chi-square test or Fisher′s exact probability method.Results The median age of 8994 children was 6.3 years.There were 2310(25.7%)children in the non-epileptic group,including 1364(59.0%)males and 946(41.0%)females.There were 6684(74.3%)children in the confirmed or suspected epileptic group,including 3842(57.5%)males and 2842(42.5%)females.In the non-epileptic group,141 cases(6.1%)had IPS photo-driving responses,and 1 case had photo paroxysmal response(PPR).In the confirmed or suspected epilepsy group,IPS photo-driving responses(2.4%)occurred in 160 cases,PPR(1.2%)in 82 cases,photo convulsion responses(0.3%)in 18 cases,and asymmetric photo-driving responses(0.2%)in 14 cases.The IPS photosensitivity responses varied among children of different ages,sexes,epileptic discharge types and seizure types in the confirmed or suspected epilepsy group.The children aged 6 to 18 years showed significantly stronger photosensitivity responses than those aged 1 to<6 years(P<0.001).The photosensitivity activity in females was 1.9 times higher than that in males.The photosensitivity activity in patients with generalized discharges was 1.7 times more intense than that in patients with focal discharges.The photosensitivity reaction in patients with photo convulsive generalized seizures was 2.5 times stronger than that in patients with focal seizures.Conclusions Routine standardized IPS is important for the detection of photosensitivity in children diagnosed or suspected with epilepsy.It can effectively guide the medical practice.