急性脑梗死视频脑电图监测异常与癫痫发作的关系研究  

Research on the Relationship between Abnormal Video-EEG Monitoring and Seizures Onset in Patients with Acute Cerebral Infarction

作　　者：张雅静 吕宪民[2] 王海英[2] 孙茜[2] 袁莉[2] 

机构地区：[1]唐山康复医疗中心综合康复科,河北省唐山市063000 [2]唐山市工人医院神经内科

出　　处：《中国全科医学》2012年第32期3785-3787,共3页Chinese General Practice

摘　　要：目的利用视频脑电图监测急性脑梗死患者脑电情况,探讨急性脑梗死患者脑电图异常与早发性及迟发性癫痫发作的关系。方法选取2008年1月—2011年1月在我院神经内科监护室住院的急性大脑半球梗死患者259例,进行连续视频脑电图监测,记录脑电图异常类型及脑梗死部位,并对患者进行1年的随访。结果 259例急性脑梗死患者中227例(88.0%)脑电图监测异常,早发性癫痫发作12例,25例患者监测到癫痫样放电而无临床发作。分水岭梗死组早发性癫痫和癫痫样放电的发生率为29.0%(9/31),部分皮层及皮层下梗死组的发生率为13.4%(21/157),完全大面积脑梗死组的发生率为9.9%(7/71);3组患者早发性癫痫和癫痫样放电的发生率比较,差异有统计学意义(χ2=6.748,P<0.05)。随访1年,有10例(4.1%)患者出现迟发性癫痫,均为视频脑电图监测异常患者,其中2例患者为脑梗死急性期脑电图监测存在癫痫样放电,8例为半球弥漫性慢波或局限性慢波;脑梗死急性期癫痫样放电患者与其他脑电图异常患者迟发性癫痫发生率比较,差异无统计学意义(χ2=0.633,P=0.426)。结论连续视频脑电图监测能够早期发现癫痫和癫痫样放电,迟发性癫痫可能出现在脑梗死急性期脑电图监测异常患者中,对该类患者应加强出院指导。Objective To investigate the relationship between abnormal EEG and early-onset and late-onset of seizures in patients with acute cerebral infarction by using video-EEG to monitor patients with acute cerebral infarction.Methods 259 patients with acute hemispheric infarction admitted to neurology department of our hospital from January 2008 to January 2011 were selected and monitored continuously by video-EEG.The abnormal types and infarction sites were recorded and the patients were followed up for one year.Results Among the 259 patients,227 cases（88.0%） had abnormal video-EEG,and 12 cases had early-onset seizures,25 cases showed epileptic discharge but without clinical onset.The incidences of seizure in watershed infarction group,part of the cortex and subcortical infarction group and completely large area cerebral infarction group were 29.0%（9/31）,13.4%（21/157） and 9.9%（7/71） respectively.The difference between the three groups was statistically significant（χ2=6.748,P0.05）.During the one year following up,10 cases（4.1%）,all of which had abnormal VEEG,showed tardy epilepsy.Of the 10 cases,2 had epileptic discharge in acute phase and 8 had hemisphere diffuse or localized slow waves.The incidences of tardy epilepsy between patients with epileptic discharge in acute phase and patients with other abnormalities showed no statistically significant difference（χ2=0.633,P=0.426）.Conclusion Continuous video-EEG can find early-onset epilepsy and epileptic discharge.The tardy epilepsy may appear in patients with abnormal video-EEG in acute phase of cerebral infarction,and these patients should follow discharge guidance carefully.

关 键 词：脑梗死 癫痫 癫痫样放电 早发性癫痫 迟发性癫痫 视频脑电图 

分 类 号：R743.33[医药卫生—神经病学与精神病学]