癫痫杂志

癫痫杂志

187 例成人睡眠相关性癫痫患者的临床特征及视频脑电图分析

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目的 总结分析成人睡眠相关性癫痫患者临床特征及视频脑电图特点,为临床诊断、鉴别诊断及治疗提供依据。 方法 收集 2017 年 1 月–2017 年 12 月在中南大学湘雅医院神经内科诊治的 187 例成人睡眠相关性癫痫患者的临床资料和常规脑电图(EEG)、长程视频脑电图(VEEG),采用 χ2 检验进行回顾性分析。 结果 临床表现:187 例成人睡眠相关性癫痫患者病程集中在 1~10 年内 101 例(54.01%);发作频率主要为 1 年发作几次至几十次 99 例(52.94%);两种或两种以上发作类型 119 例(63.64%);其中发作表现为局灶性起源 121 例次(39.29%),局灶进展为双侧强直阵挛 152 例次(49.35%);两种及以上药物治疗 110 例(58.82%)。EEG 结果:① 常规 EEG 癫痫样放电检出率为 22.78%,VEEG 癫痫样放电检出率为 80.43%,两种检查方法比较差异有统计学意义(P <0.01);② 发作间期常规 EEG 监测到 18 例癫痫样放电,VEEG 监测到 111 例癫痫样放电;③ 监测到 56 次发作性事件,均发生在 VEEG 监测过程中;其中 50 次发生在睡眠期(89.29%),6 次发生在清醒期(10.71%);结合临床 45 次(80.36%)确诊为癫痫发作,9 次(16.07%)确诊为非癫痫发作,不能确定其发作性质 2 例(3.57%);④ VEEG 监测中睡眠期癫痫样放电检出率高于清醒期,差异有统计学意义( P<0.01)。睡眠分期中 NREMⅠ–Ⅱ期癫痫样放电检出率所占比例最高。 结论 成人睡眠相关性癫痫具有一定的临床特征和 EEG 表现,VEEG 相较常规 EEG 更能提高癫痫样放电的检出率,且对睡眠期发作事件的定性提供诊断依据,并能反映癫痫样放电与睡眠之间的关系,对成人睡眠相关性癫痫的临床诊治提供依据。

Objective To summarize and analyze the clinical and video-EEG (VEEG) characteristics of adult sleep-related epilepsy, so as to provide evidence for clinical diagnosis, differential diagnosis and treatment. Methods The clinical data, routine EEG and long-term VEEG of 187 adult patients with sleep-related epilepsy treated in Department of Neurology, Xiangya Hospital, Central South University from January 2017 to December 2017 were retrospectively analyzed by χ2 test. Results Clinical manifestations: The duration of sleep-related epilepsy in 187 adults was concentrated in 1~10 years (101 cases, 54.01%); the frequency of seizures was mainly from several to dozens of times a year (99 cases, 52.94%); 119 cases (63.64%) had two or more types of seizures. Among the patients, 121 cases (39.29%) had focal origin, 152 cases (49.35%) had bilateral tonic clonus and 110 cases (58.82%) were treated with two or more drugs. EEG results: ① The detection rate of epileptiform discharges in routine EEG was 22.78%, and that in long-term video EEG was 80.43%. There was significant difference between the two methods (P< 0.01); ② Eighteen epileptiform discharges were monitored by routine EEG during interparoxysmal period and 111 epileptiform discharges were monitored by video EEG; and ③ Fifty-six epileptic events were monitored and all occurred in the process of long-term VEEG monitoring, 50 of them occurred in sleep (89.29%) and 6 in awake (10.71%); 45 cases (80.36%) were diagnosed as epileptic seizures, 9 cases (16.07%) were diagnosed as non-epileptic seizures, and 2 cases (3.57%) could not be determined. ④ The detection rate of epileptic discharges during sleep was higher than that during awake period in long-term VEEG monitoring (P< 0.01). The detection rate of epileptiform discharges in NREM stage I–II was the highest in sleep stage. Conclusion Sleep-related epilepsy in adults has certain clinical features and EEG manifestations. Compared with conventional EEG, long-term video-EEG can improve the detection rate of epileptiform discharges, provide diagnostic basis for the qualitative analysis of sleep-related seizures, and reflect the relationship between epileptiform discharges and sleep, and provide basis for the clinical diagnosis and treatment of sleep-related epilepsy in adults.

关键词: 睡眠; 癫痫行为学; 视频脑电图; 癫痫样放电

Key words: Sleep epilepsy; Behavioristics; Video-EEG; Epileptiform discharge

引用本文: 黄莎, 肖波, 冯莉, 龙莉莉, 龙泓羽, 谢媛媛, 赵海婷, 呙丹妮, 姜海燕, 彭金鑫. 187 例成人睡眠相关性癫痫患者的临床特征及视频脑电图分析. 癫痫杂志, 2019, 5(1): 16-20. doi: 10.7507/2096-0247.20190003 复制

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