难治性癫痫患者全面性抽搐发作后全面脑电抑制相关的临床因素研究  

Clinical factors associated with postictal generalized EEG suppression after generalized convulsive seizures in patient with refractory epilepsy

作　　者：周超[1] 但炜[1] 王刚[1] 张兆斯 谢延风[1] 石全红[1] 詹彦[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2016年第14期1669-1673,共5页Journal of Third Military Medical University

基　　金：重庆市卫生局重点课题(2012-1-008);国家临床重点专科建设项目[财社(2011)170号]~~

摘　　要：目的通过分析难治性癫痫患者全面性抽搐发作(generalized convulsive seizures,GCS)的临床和视频脑电图资料,探讨影响发作后全面脑电抑制(postictal generalized EEG suppression,PGES)发生的临床因素。方法回顾性分析于我院神经外科2010年9月至2015年7月就诊的57例难治性癫痫患者96次GCS的临床和视频脑电资料。比较PGES(+)与PGES(-)患者在性别、年龄、病因、致痫灶部位和GCS的发作频率、症状类型、持续时间、觉醒状态、吸氧等方面的差异,探讨影响PGES发生的临床因素。结果 24例(42.1%)患者36次(37.5%)GCS后出现PGES,持续(45.4±38.5)s。颞叶癫痫比颞叶外癫痫PGES出现率高(70.6%vs 26.7%,P=0.03);PGES的出现率在双侧对称强直伸展型GCS中比单纯阵挛型GCS和不对称强直型GCS高(48.2%vs 13.3%vs 28.0%,P=0.02);在睡眠中发作比清醒中高(47.1%vs 26.7%,P=0.04);在发作后朦胧静止状态比自由活动状态高(45.6%vs 0,P<0.01);在发作后早期吸氧比不吸氧低(20.6%vs 46.8%,P=0.01)。PGES(+)的发作比PGES(-)的发作平均强直持续时间长[(10.7±6.6)vs(7.7±2.1)s,P=0.03],而性别、年龄、病因、GCS发作频率与PGES的发生没有关联(P>0.05)。结论颞叶癫痫、双侧对称强直伸展型GCS、睡眠中发作和发作后朦胧静止状态更易出现PGES,而发作后早期吸氧可降低PGES的发生。Objective To investigate the clinical factors associated with postictal generalized EEG suppression （PGES） after generalized convulsive seizures （GCS） through analyzing clinical and video- electroencephalography （VEEG） data in patients with refractory epilepsy. Methods The clinical data and VEEG records of 96 GCS in 57 patients, who were monitored in our neurosurgery department from September 2010 to July 2015, were retrospectively reviewed. Differences of sex, age, aetiology, seizure focus, seizure frequency, seizure type of semiology, seizure duration, stage of wakefulness, and administration of oxygen between patients with PGES and patients without PGES were systematically analyzed. Enumeration data were assessed by Chi square test and measurement data were assessed by Mann-Whitney U test. Results PGES was observed in 36 （37.5%） patients and 24 （42.1%） GCSs. The duration of PGES was 45.4±38.5 s. The incidence of PGES in the temporal lobe epilepsy was higher than that outside the temporal lobe epilepsy （70.6% vs 26.7% , P = 0.03 ）. The incidence of PGES in tonic-clonic GCS with bilateral and symmetric tonic arm extension was higher than that in clonic GCS without tonic arm extension or flexion and that in GCS with unilateral or asymmetric tonic arm extension or flexion （48.2% vs 13.3% vs 28.0%, P =0.02）. The incidence of PGES in GCS during asleep period was higher than that during awake period （47.1% vs 26.7% , P = 0.04）. The incidence of PGES in unconsciousness or motionlessness was higher than that in consciousness or free movement at seizure ends （45.6% vs 0, P 〈0.01 ）. The incidence of PGES after early administration of oxygen was lower than that not giving oxygen at seizure onset. （20.6% vs 46.8% , P =0. 01 ）. The mean duration of tonic phase of GCS with PGES was higher than that without PGES （ 10.7± 6. 6, vs 7.7±2.1 s, P =0.03 ）. No statistical difference was observed in the other variables such as sex, age, aetiology and seizure frequency. Conclusion The i

关 键 词：癫痫 发作 脑电抑制 影响因素 

分 类 号：R181.32[医药卫生—流行病学] R741.044[医药卫生—公共卫生与预防医学]