瞬目诱发相关癫痫的电-临床研究

Clinical and neurophysiological characteristics of epilepsy with blink inducing

目的分析瞬目诱发相关癫痫的电-临床特点。方法收集2017年5月至2022年5月于空军军医大学西京医院神经内科脑电监测中心接受24 h视频脑电图(24 h-VEEG)监测,且符合瞬目诱发诊断标准的癫痫患者,分析瞬目诱发相关癫痫的电-临床特点,并对所有入组患者进行随访,观察其预后。结果共纳入伴有瞬目诱发相关的癫痫患者42例,其中1例失访。41例患者中男性18例(44%),女性23例(56%),24 h-VEEG监测期间出现瞬目诱发现象者的年龄为3~12(8.1±2.6)岁,其中伴中央颞区棘波的自限性癫痫(SeLECTS)35例,伴自主神经发作的自限性癫痫3例,发育性癫痫性脑病伴睡眠期棘慢波放电3例。其中31例(76%)伴有睡眠中癫痫性电持续状态(ESES),10例(24%)不伴有ESES。32例患者做过2次以上24 h-VEEG,按最后1次复查脑电图时有无发作分为无发作组(23例,其中14例瞬目诱发消失,9例持续存在)和有发作组(9例,其中3例瞬目诱发消失,6例持续存在),两组间瞬目诱发情况差异无统计学意义(P>0.05)。治疗后复查24 h-VEEG瞬目诱发消失的患者年龄为(11.3±3.1)岁,未消失组年龄(9.1±2.3)岁,两组间差异有统计学意义(t=2.254,P=0.030)。结论瞬目诱发多见于自限性局灶性癫痫或发育性癫痫性脑病,以SeLECTS更为常见;伴有ESES的癫痫患者更易出现瞬目诱发。瞬目诱发与癫痫预后无相关性,可能具有高度的年龄依赖性。

Objective To summarize the clinical and neurophysiological characteristics of epilepsy with blink inducing.Methods The patients with epilepsy with blink test positive who received 24 h-video-electroencephalography(24 h-VEEG)monitoring from May 2017 to May 2022 in the Xijing Hospital,the Air Force Military Medical University were enrolled.Their clinical and electrophysiological characteristics were studied and they were followed up to observe their prognosis.Results A total of 42 patients with epilepsy with blink test positive were collected,1 of whom was lost to follow-up.The remaining 41 patients included 18 males(44%)and 23 females(56%),whose age was 3 to 12(8.1±2.6)years.Self-limited epilepsy with centrotemporal spikes(SeLECTS)was diagnosed in 35 patients,self-limited epilepsy with autonomic seizures in 3,and developmental epileptic encephalopathy with spike-and-wave activation in sleep in 3,respectively.The electrical status epilepticus during sleep(ESES)was found in 31 patients(76%),whereas 10(24%)without ESES.Thirty-two patients experienced 24 h-VEEG monitoring more than twice,and 23 of them were seizure free,of whom blink inducing disappeared in 14 patients and existed in 9 in the last 24 h-VEEG monitoring.Among the 9 patients who were not seizure free,blink inducing disappeared in 3 patients and remained in 6.There was no statistically significant difference between the two groups(P>0.05).The age of the patients whose blink inducing disappeared in the last 24 h-VEEG monitoring after treatment was(11.3±3.1)years.Meanwhile the age of the patients whose blink inducing remained was(9.1±2.3)years,and the difference between the two groups was statistically significant(t=2.254,P=0.030).Conclusions Blink inducing is highly age-dependent and common in self-limited focal epilepsy and developmental epileptic encephalopathy,especially in SeLECTS.Moreover,patients with ESES are more likely to be blink test positive.There was no correlation between blink inducing and seizure outcome.