基于V—EEG视频分析的儿童癫癎症状学评估  

Semiological analysis in epileptic children according to Video-EEG

作　　者：任志伟[1] 张国君[1] 遇涛[1] 杜薇[1] 黄朝阳[1] 

机构地区：[1]首都医科大学宣武医院,北京功能神经外科研究所,北京100053

出　　处：《癫痫与神经电生理学杂志》2013年第3期151-154,共4页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨长程同步录像脑电图（V—EEG）上的行为学分析在儿童癫癎患者术前评估中的应用价值。方法：对我中心癫癎外科手术的儿童患者（小于13岁）进行随访，追踪术后一年以上无发作且术前至少有一次发作期录像的病人45例，通过分析V-EEG中病人发作期录像表现，找出与致癎灶定侧高度相关的症状体征，对比发作症状学和脑电图（EEG）的定侧结果。结果：在41例（91％）中观察到定侧体征，包括一侧强直、阵挛等发作期定侧体征14种，擦鼻子等发作后定侧体征3种。其中37例（82％）可以通过发作中定侧体征正确定侧，观察者间一致性较高（x=0．85）。对比症状学和EEG的定侧结果基本一致。结论：绝大多数癫癎患儿均可通过发作中定侧体征正确定侧。儿童癫癎术前评估应用录像作症状学分析为EEG的有力补充，同样有助于定位致癎灶，在EEG不能定侧或由于电极的空间分辨率受限的情况下，尤其有助于制定手术方案。Objective：To investigate the value of long-term vedio-EEG semiological analysis in presurgical evaluation of epileptic children. Methods： The children （〈13 years） with epilepsy surgery in our center was retrospectively examined. Forty-five patients were seizure free after surgery with a minimum follow-up duration of more than 1 year, having at least one video record seizure. Video recordings were reviewed to find out lateralizing signs with high significance among varies clinical symptoms The lateralizing results of semiology and EEG were compared. Results： Forty-one children had lateralizing signs （LSs） with 14 ictal lateralizing signs（unilateral tonic seizure, unilateral clonic seizure; and so on）, and 3 postictal signs（postictal nosewiping, and so on）. With LSs＇ combination,3？ cases（82%）were correctly lateralize children. Overall interobservers＇ agreement was very good （k=0.85）. The analysis results of both semiology and EEG were in substantial agreement. Conclusion： Most children can be correctly lateralized with LSs. The detailed analysis of semiology can be a valuable addition of EEG, during the location of epileptogenic zone, with the pre-surgical evaluation of epileptic children. Especially, when the analysis of EEG had no lateralizing value or there was limitation of electrodes＇ spatial resolution, semiological analysis can contribute to the surgical plan.

关 键 词：癫癎 症状学 定侧 同步录像脑电图(V-EEG) 儿童 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]