癫痫EEG讲稿

PLS’09Beijing,China,September7,2009癫痫EEGPLS’09Beijing,China,September7,2009癫痫的诊断依据临床表现：发作性•意识障碍•抽搐•或伴感觉、精神或植物神经功能障碍脑电图特点：发作性vs持久性•痫样放电PLS’09Beijing,China,September7,2009PLS’09Beijing,China,September7,2009癫痫脑电图•神经科各种先进检查技术已有突飞猛进的发展，如CT、MRl、SPECT及DSA等，不仅能看见大脑的形态结构，而且能了解大脑的功能，提示癫痫病灶位置等，为寻找癫痫发病原因和手术切除癫痫病灶提供了科学证据。•但在癫痫诊断方面这些并不能替代脑电图检查，因为癫痫发病的基础是脑神经细胞的异常放电，只有EEG能发现这种异常脑电活动。PLS’09Beijing,China,September7,2009癫痫脑电图•脑电图可以帮助医生确定患者是不是癫痫。•确定是什么类型的癫痫。•是否需要服用抗癫痫药物，选择哪一种抗癫痫药物。•是否可以减停抗癫痫药物，停药后复发的风险如何。PLS’09Beijing,China,September7,2009癫痫脑电图•癫痫病人不仅在发作时有异常脑电图，约50%的病人在发作间歇期也可看到异常脑电活动，统称为痫样放电。•痫样放电的特点的在基本电活动上突然产生的，一般是高波幅的电活动。PLS’09Beijing,China,September7,2009各种癫痫发作的脑电图PLS’09Beijing,China,September7,2009强直-阵挛性发作：发作间期的脑电图•在强直-阵挛性发作间歇期，70~80%病人的脑电图有不同程度的异常：•1发作性异常波•2非发作性异常波•异常脑电图一般频繁发作者容易出现，而发作间期长者例如一年左右一次者，脑电图可以正常。PLS’09Beijing,China,September7,2009广泛性（全面性）多棘慢复合波阵发PLS’09Beijing,China,September7,2009GeneralizeSpikeWaveDischargePLS’09Beijing,China,September7,2009癫痫发作期的脑电图表现•与发作间期痫样放电相似，是这种发作间期痫性放电的延续。•有些则与发作间期的脑电图表现完全不同，出现一种全新的脑电图模式：脑电低平；募集节律；爆发性放电PLS’09Beijing,China,September7,2009IctalEEG–Abnormalrhythmwithsudden,steepincreaseinamplitude–Associatedwithincrease/decreaseinfrequencycontent–Mayvaryconsiderablyfromseizuretoseizure–hardtodetectPLS’09Beijing,China,September7,2009Abnormalrhythmwithsudden,steepincreaseinamplitudePLS’09Beijing,China,September7,2009readingPerceptionoffearAlteredconsciousnessRighthemi-sphereLefthemi-spherePLS’09Beijing,China,September7,2009PLS’09Beijing,China,September7,2009肌阵挛发作–为突然发生的快速有力的“电击状”肌肉收缩–常致快速跌倒–整个发作过程大约0.2秒–EEG：全导高波幅多棘慢波短程爆发。–EMG：一过性肌电爆发（100ms）。–可见于多种良性或非良性全面性癫痫综合征。PLS’09Beijing,China,September7,2009肌阵挛发作MyoclonicSeizureandPolyspikeWaveJerkJerkPLS’09Beijing,China,September7,2009失神发作•典型表现为规律性的反复出现而波幅一致的频率3次/S(2．5～4次/S)的棘波与慢波特殊结合•通常为两侧半球同步性放电，在额顶区较明显，且电压较高，可达300μV左右PLS’09Beijing,China,September7,2009全面性3Hz棘慢复合波节律暴发PLS’09Beijing,China,September7,2009ThisEEGdisplaysanabnormaldischargecalledageneralizedspikeandwave.ThisEEGpatternistypicalforabsenceseizures.PLS’09Beijing,China,September7,2009Absence:3HzSpikeandWavePLS’09Beijing,China,September7,2009AtypicalAbsenceSeizures•Theictalsymptomsfluctuatedandconsistedofstaring,headnoddingandautomatisms.•TheictaldischargeconsistedofslowGSWDat2–2.5Hz.PLS’09Beijing,China,September7,2009失神发作继发GTCSPLS’09Beijing,China,September7,2009失张力发作–临床表现：低头、弯腰、屈膝，向后快速跌倒坐地。持续数秒钟或数分钟。–EEG：弥漫性棘慢波或广泛性电压抑制。–EMG：一过性电静息。–常见于Lennox-Gastaut综合征。PLS’09Beijing,China,September7,2009肌阵挛后失张力•VideoEEGofaDooseSyndrome6-Year-OldNormalBoywith•Somejerkswerefollowedbyatonicattacks.TheEEGalsoshowedbrief(0.5s)abortivegeneraliseddischargesofpolyspikesataround15HzPLS’09Beijing,China,September7,2009–临床表现：突然发生的意识丧失，全身肌肉强直收缩，固定于某种姿势5-20秒–多表现为突然低头、弯腰、四肢强直伸展，致跌倒–EEG：广泛性10－20Hz快节律–EMG：持续性肌电爆发（持续数秒）–常见于Lennox-Gastaut综合征睡眠中短暂的强直发作–睡眠中突然睁眼，双眼向上凝视，持续数秒–EEG为广泛性10～20HZ棘波节律–常被家长忽视–如持续时间长，可见轴性强直–见于LGS强直发作PLS’09Beijing,China,September7,2009•EEGfastparoxysmsareassociatedwithinconspicuousmanifestationsoftonicseizures(slighttoniceyelidopening)thatwouldbeimpossibletodetectwithoutvideo–EEGrecording.PLS’09Beijing,China,September7,2009•Atonicseizuremanifestingwithmildclinicalsymptomsoccursduringmarkedparoxysmalfastactivity.TurningoftheheadandsymmetricalflatteningoftheEEGfollowthis.PLS’09Beijing,China,September7,2009轻微强直发作•Fastparoxysmsoftencontainrhythmsfasterthan10HzinLennox–Gastautsyndrome.PLS’09Beijing,China,September7,2009痉挛发作•最常见于West综合征•也可见于其他婴儿癫痫综合征：Ohtahara综合征•特殊的发作形式（点头、四肢屈曲或伸展）•多数为成串发作，也可单次发作•持续时间1-3秒，比肌阵挛发作（0.2秒）慢，比强直发作（5-20秒）快•发作间期EEG为高度失律（高峰节律紊乱）•发作期EEG：快波节律；高幅慢波；广泛去同步化PLS’09Beijing,China,September7,2009Ohtahara综合征也称大田原综合征•大田原综合征的起病年龄在3个月之内，多数早至1个月之内。主要发作类型为痉挛性发作，可以为成串发作，类似婴儿痉挛发作，也可仅为单次痉挛。清醒和睡眠期均可有发作。其他发作形式如部分运动性发作、半侧惊厥发作也可出现，但很少有肌阵挛发作。•患儿有严重的精神运动发育落后或停滞。•神经影像学常有明显的异常发现。•暴发——抑制是大田原综合征的特征性表现，也是本症重要的诊断依据。睡眠及清醒时持续存在。也可为不对称或不同步的爆发一抑制。•本症与婴儿痉挛症的主要鉴别点为后者起病年龄稍晚（高峰为4-6个月），EEG主要表现为高峰节律紊乱。PLS’09Beijing,China,September7,2009Ohtaharasyndrome•FIG.1.InterictalEEGofa2-month-oldboywithOhtaharasyndromeshowsbilaterallysynchronoussuppression-burstpatternbothduring(above)wakefulnessand(below)sleep.Calibrationsare1secondand50microvolts.From:Ohtahara:JClinNeurophysiol,Volume20(6).November/December2003.398-407PLS’09Beijing,China,September7,2009West综合征•3-7个月婴儿多见•发育迟缓•屈颈、弯腰样发作•EEG上呈高峰失律PLS’09Beijing,China,September7,2009HypsarrhythmiaPLS’09Beijing,China,September7,2009Hypsarrhythmia•FIG.2.Digitalrecordingofahypsarrhythmicpatternina23-month-oldinfant.PLS’09Beijing,China,September7,2009HypsarrhythmiawithIncreasedInterhemisphericSynchronization•FIG.3.Digitalrecordingofhypsarrhythmiawithincreasedinterhemisphericsynchronizationina22-month-oldinfant.Noteincreasedsynchronizationoffrontalslowandsharpandslowwaveactivity.Sampleshownatreducedsensitivity.PLS’09Beijing,China,September7,2009AsymmetricHypsarrhythmia•FIG.4.Digitalrecordingofasymmetrichypsarrhythmiaina13-month-oldinfant.Sampleshownatreducedsensitivity.PLS’09Beijing,China,September7,2009HypsarrhythmiawithEpisodesofVoltageAttenuation•FIG.6.Digitalrecordingofsuppression-burstvariant