抗N-甲基-D-天冬氨酸受体脑炎患者脑电图分析  

Analysis of electroencephalogram feature in patients with anti-N-methyl-D-aspartate receptor encephalitis

作　　者：王凌玲[1] 王小姗[1] 葛剑青[1] 郁媛文 余传勇[1] 吴迪[1] 刘华曲 苗爱亮 Wang Lingling;Wang Xiaoshan;Ge Jianqing;Yu Yuanwen;Yu Chuanyong;Wu Di;Liu Huaqu;Miao Ailiang(Department of Neurology,the Affiliated Brian Hospital of Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,江苏210029 [2]江苏宿迁沭阳中山医院

出　　处：《脑与神经疾病杂志》2020年第12期752-756,共5页Journal of Brain and Nervous Diseases

基　　金：江苏省青年医学重点人才(QNRC2016053);国家自然科学基金青年项目(81501126);南京医科大学附属脑科医院青年人才项目

摘　　要：目的探讨抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎特征性脑电图(EEG)改变,以提高临床对此疾病诊断。方法分析南京医科大学附属脑科医院神经内科2017年4月至2020年6月期间收治的4例抗NMDAR脑炎患者临床、影像及视频EEG资料。结果本组4例患者3例为女性,1例为男性。年龄分别为32岁、19岁、50岁、19岁。4例患者在疾病高峰期均出现特征性9~12 Hz节律活动。例1患者视频EEG示右侧额极、前颞δ刷,10s后逐渐演变为9~10 Hz节律活动,其中夹杂小尖波,60s后又演变为δ刷。例2患者视频EEG示左侧额极、颞区起源14 Hz低幅快波2s后演变为9~12 Hz节律活动,并持续55s,最后演变为θ和δ慢波持续10s后结束。例3患者右侧颞区10~11 Hz节律活动,持续6s。以上3例患者当出现9~12 Hz节律活动时无客观临床症状。例4患者复发后视频EEG示左侧额区起始15 Hz快节律,5s后演变为9~12 Hz节律,同时伴有右侧嘴角抽搐,持续40s左右。本文推测抗NMDAR脑炎患者额颞区9~12 Hz节律活动很可能是临床下发作的一种模式或发作期的一种模式。结论本文发现除δ刷外,额颞区9~12 Hz节律也是抗NMDAR脑炎患者EEG特征。临床中若具有脑炎症状的患者EEG出现额颞区9~12 Hz节律活动,提示抗NMDAR脑炎可能。Objective To explore electroencephalogram(EEG)characteristic and improve dignosis in patients with anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis.Methods The clinical,imaging and video EEG data from 4 paitents with anti-NMDAR encephalitis in our hospital from April 2017 to June 2020 were retrospectively analyzed.Results Three patients of them were female,and one patient was male.Their ages at the disease onset were 32,19,27,50 and 19 years old,respectively.The characteristic 9-12 Hz rhythmic activity was observed in all patients at the peak of the disease.Extreme delta brush(EDB)in the right frontal pole regions from case 1 was gradually attenuated and evolved rhythmic 9-12 Hz waves after 10 seconds which mixed with a few sharp waves and lasted up to 80 seconds in the right temporal lobe.Subsequently,rhythmic 9-12 Hz activity weakened but EDB became enhanced.In case 2,14 Hz low amplitude fast wave originating from left frontal pole and temporal area lasted for 2 seconds,and evolved into 9-12 Hz rhythmic activity.Subsequently,9-12 Hz rhythmic activity continued for 55 seconds,and evolvedθandδwave lasting 10 seconds.In case 3,10-11 Hz rhythmic activity in the right temporal region lasted for 6 seconds.The above 3 patients had no objective clinical symptoms during 9-12 Hz rhythmic activity.In case 4,15 Hz fast rhythm in the left frontal area developed into a 9-12 Hz rhythmic activity after 5 seconds.The rhythmic 9-12 Hz activity lasting for about 40 seconds was accompanied by convulsions in the right corner of the mouth.We speculate that the 9-12 Hz rhythmic activity in frontotemporal region of patients with anti-NMDAR encephalitis may be a pattern of clinical seizure or subclinical seizure.Conclusions In addition to EDB,we found that the rhythm of 9-12 Hz in frontotemporal region was also the EEG feature of anti-NMDAR encephalitis patients.The 9-12 Hz rhythmic activity in frontotemporal region suggested patients with anti-NMDAR encephalitis.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 脑电图 9~12Hz节律活动 

分 类 号：R742.9[医药卫生—神经病学与精神病学]