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  

The analysis of clinical characteristics and video EEG in adult patients with sleep related epilepsy in 187 cases

作　　者：黄莎[1] 肖波[1] 冯莉[1] 龙莉莉[1] 龙泓羽[1] 谢媛媛 赵海婷[1] 呙丹妮 姜海燕[1] 彭金鑫[1] HUANG Sha;XIAO Bo;FENG Li;LONG Lili;LONG Hongyu;XIE Yuanyuan;ZHAO Haiting;GUO Danny;JIANG Haiyan;PENG Jinxin(Department of Neurology,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院神经内科,长沙410008

出　　处：《癫痫杂志》2019年第1期16-20,共5页Journal of Epilepsy

摘　　要：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χ~2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 χ^2 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

关 键 词：睡眠 癫痫行为学 视频脑电图 癫痫样放电 

分 类 号：R742.1[医药卫生—神经病学与精神病学]