表现为非惊厥性癫痫持续状态的边缘叶脑炎的临床和脑电图特征  

Clinical and electroencephalographic features of limbic encephalitis performed as nonconvulsive status epilepticus

作　　者：汪芳[1] 邵良[2] 黄怀宇[2] 盛美红[3] 凌卓敏[1] 

机构地区：[1]南通大学第二附属医院脑电图室,226001 [2]南通大学第二附属医院神经内科,226001 [3]南通大学第二附属医院影像科,226001

出　　处：《临床神经病学杂志》2016年第4期259-262,共4页Journal of Clinical Neurology

摘　　要：目的探讨为非惊厥性癫痫持续状态(NCSE)的边缘叶脑炎(LE)的临床及EEG特征。方法回顾性分析9例表现有NCSE的LE患者的临床资料。结果 4例患者为急性起病,5例为亚急性起病。首发症状为复杂部分性癫痫持续状态(CPSE)7例,轻微发作癫痫持续状态(SSE)1例,简单部分性癫痫持续状态(SPSE)1例。9例患者均有精神症状、记忆障碍及自主神经功能紊乱,肺癌1例。头颅MRI显示脑实质急性炎症,主要集中于边缘系统,呈双侧对称或不对称信号异常改变,T_1WI为略低信号,T_2WI及Flair呈高信号。EEG表现为θ波背景6例,均可见δ波,其中棘慢波或尖慢波4例;α波背景2例,均可见δ波,表现为δ波背景1例。视频脑电图(VEEG)示1例SSE患者呈持续的痫性放电,在病侧蝶骨电极更显著,但无运动性癫痫发作。1例SPSE患者在皮质和颞近中央区有不同频率的局灶性棘波或棘慢综合波持续发放。7例CPSE患者呈颞区为主的各种形式癫痫性电活动广泛持续发放或反复阵发性出现,如节律性的棘波、尖波、δ或/和θ节律,可向邻近区域或对侧半球扩散,或左右交替;在无凝视反应或刻板自动症时呈现扩散至双侧半球的高波幅棘慢综合波或δ节律爆发。结论表现有NCSE的LE的临床和EEG有特征性改变,EEG和VEEG是LE是否存在NCSE的主要诊断依据。左右半球边缘叶病变出现的精神症状并不相同。各型LE对治疗反应不一,非副肿瘤性LE疗效较满意。Objective To investigate the clinical and EEG features of limbic encephalitis（ LE） performed as nonconvulsive status epilepticus（ NCSE）. Methods The clinical data of 9 LE patients with NCSE were retrospective analyzed. Results Four cases were acute onset,and 5 cases were subacute onset. The first symptom was complex partial status epilepticus（CPSE） in 7 case,mild episodes of status epilepticus（ SSE） in 1 cases,and simple partial status epilepticus（ SPSE） in 1 case. There were mental symptom,memory disorders and autonomic nervous dysfunction was in 9 cases,and lung cancer was in 1 case. Brain MRI showed brain parenchyma had acute inflammation,and it mainly concentrated in limbic system. It was symmetry in twin sides with abnormal MR signal,lightly hyperintensity on T_1WI,hyper signal on the T_2WI and Flair. EEG showed theta wave background was in 6 cases,and visible delta waves in all 6 patients,and spike and slow wave or spike slow wave in 4 cases; alpha wave background was in 2 cases,visible delta waves in all of them,and delta wave background was in 1 case. Video EEG（VEEG） showed sustained epileptic discharge in a patient with SSE,especially under the sphenoidal electrodes of diseased side,but without motor seizures. One patient with SPSE found focal spike wave or spike and slow complex wave of different frequencies in the cortex and temporal near central area. Seven cases with CPSE presented widely extended or paroxysmal repeated various types of epileptic activities mainly in temporal region,such as rhythmic spike wave,sharp wave,delta wave and / or theta wave,which could spread to adjacent area or contralateral hemisphere or even alter from left to right. Moreover,the outbreak of spike and slow complex wave or theta rhythm of high amplitude was found in no gaze reaction and rigid automatism. Conclusions There are clinical and EEG characteristic changes of LE with NCSE. EEG and VEEG are the diagnostic basis of NCSE in LE. Mental symptoms of bilateral limbic lobe are different. The ther

关 键 词：边缘叶脑炎 非惊厥性癫痫持续状态 EEG 临床特点 

分 类 号：R742.1[医药卫生—神经病学与精神病学]