VEEG在误诊为癫痫的发作性疾病中的应用价值  

作　　者：吴菡[1] 赵泽仙 汤业磊[2] 郭谊[2] 王钟瑾[2] 王爽[2] 

机构地区：[1]浙江中医药大学附属第二医院,310005 [2]浙江大学附属第二医院,310009

出　　处：《浙江临床医学》2014年第12期1896-1897,共2页Zhejiang Clinical Medical Journal

摘　　要：目的：分析视频脑电监测（VEEG）对误诊为癫痫发作性疾病的诊断价值。方法回顾性分析经VEEG检查对曾被误诊为癫痫而最终明确诊断为非癫痫性发作的病例共18例。入选标准：VEEG检查捕捉到发作，并结合病史分析、发作期床旁评价、通过多学科讨论，排除是癫痫发作的患者。结果 VEEG共记录到200余次的发作；3例有明显的诱因；1例伴小便失禁。18例患者VEEG发作间期、发作期均未见明显痫样放电。分析该18例患者的发作特点、脑电图表现，最终明确发作形式为非癫痫性心因性发作（NEPS）9例、头晕2例、低血糖发作2例，抽动障碍1例、肌张力增高1例、肌阵挛1例、睡眠障碍1例、运动诱发运动障碍1例。结论不少非癫痫性发作与癫痫在临床表现、发作形式方面非常相似。对于病程较长、抗癫痫药长期控制不佳的癫痫患者，应该重新评价非癫痫性发作的可能，及早行长程VEEG监测有利于明确诊断。ObjectiveTo study the value of VEEG in paroxymal diseases of epilepsy misdiagonosing.MethodsTotal eighteen VEEG examination cases,of which had been misdiagonosed as epilepsy but confirmed as non-epileptic seizures,were collected from the hospital. Inclusion criteria：The paroxysm is captured by VEEG check,while the patients are excluded from eileptic seizures,combined with a history of analysis and multidisciplinary discussion.ResultsVEEG had recorded more than 200 times seizures,three of which had obvious causes,one of which had incontinence of urine. No obvious epileptiform discharges were discovered in ictal interictal and ictal VEEG of Eighteen patients. By Analysing seizure characteristics and VEEG results of the Eighteen patients,nine cases were nonepileptic psychogenic seizures,two cases were dizziness,two cases were hypoglycemic episodes, one case was tic disorder,one case was hypermyotonia,one case was myoclonus,one case was sleep disorder,and one case was paroxysmal kinesigenic dyskinesia.ConclusionMany non-epileptic seizures and epilepsy in clinical manifestation are very similar. For whom had a longer course of disease and poor long-term control of antiepileptic drugs,reevaluating the possibility of non epileptic seizures and taking the VEEG soon as possible are useful in diagnosis.

关 键 词：非癫痫性发作 视频脑电监测 心因性发作 

分 类 号：R741.044[医药卫生—神经病学与精神病学]