抗N-甲基-D-天冬氨酸受体脑炎脑电图动态演变分析  

Longitudinal electroencephalographic(EEG) finding in anti-N-methyl-D-aspartate(Anti-NMDA) receptor encephalitis

作　　者：李静[1] 杨丽娟 李敏[1] 舒崖清[1] 孙晓渤[1] 杨渝[1] 鲍健[1] 伍爱民[1] 陆正齐[1] 邱伟[1] LI Jingf YANG Lijuan;LI Min;SHU Yaqing;SUN Xiaobo;YANG Yu;BAO Jian;WU Aimin;LU Zhengqi;QIU Wei(Department of Neurology, the Third Affiliated Hospital o f Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院神经内科,广州510630

出　　处：《中国神经精神疾病杂志》2018年第2期65-69,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎不同临床时期的脑电图(electroencephalographic,EEG)特征。方法纳入30例抗NMDA受体脑炎患者临床资料回顾性分析,共收集58份EEG资料,按临床病程分为早期(4份),高峰期(23份),好转期(16份),恢复期(15份);疾病高峰期按病情轻重分为轻症组(10例)、重症组(13例),分析病程不同时期、不同病情的EEG特点。结果病程早期及恢复期EEG枕区背景节律保留率为100%(19/19),高峰期为39.1%(9/23),好转期为81.2%(13/16)。全面性节律性δ活动(generalized rhythmic delta activity,GRDA)仅出现在疾病高峰期(34.8%,8/23)和好转期(12.5%,2/16)。疾病高峰期,轻症组EEG多数为弥漫性混合慢波(90%,9/10),重症组GRDA及极度δ刷(extreme delta brush,EDB)图形出现率高于轻症组(P<0.05)。疾病高峰期监测到局灶性癫痫发作3例,其中1例为癫痫持续状态。高峰期、好转期、恢复期均可监测到局灶性癫痫样放电。结论抗NMDA受体脑炎EEG枕区背景节律及GRDA图形随病程演变并逐渐恢复,疾病高峰期重症患者常出现GRAD和EDB图形,病程各期均可检出癫痫样放电,多为局灶性。Objective To investigate electroencephalographic（EEG） characteristics of anti-N-methyl-D-aspartate（anti-NMDA） receptor encephalitis during different courses of the disease. Methods This study enrolled 30 cases of anti-NMDA receptor encephalitis patients. A total of 58 EEG monitoring reports and their clinical data were retrospectively analyzed based on different disease courses and severity of disease. According to the clinical stages,EEG data was divided into 4 phases： the initial stage（4）, the peak stage（23）, the improvement stage（16） and the recovery stage（15）. Based on severity of disease during the peak stage, patients were divided into mild group（10 cases）and severe group（13 cases）. Results Occipital background activity of the EEG was presented in all patients（100%）in the initial stage and in the recovery stage, in 39.1%（9/23）in the peak stage and in 13/16（81.2%）in the improvement stage. Generalized rhythmic delta activity（GRDA） pattern could only be detected in the peak stage and the improvement stage. In the peak stage, the main presentation of abnormal EEG was diffuse slow-wave（9 cases,90%） in mild group. GRDA and extreme delta brush（EDB） were more common in severe group than in mild group（P〈0.05）. Three focal epilepsy including one status epilepticus were detected in three patients in the peak stage. Focal epileptiform discharges in EEG existed in the whole course. Conclusion Occipital background activity and GRDA pattern are evolved and gradually recovered during the course of the disease. The EEG patterns of GRDA and EDB are common in severe anti-NMDA receptor encephalitis patients in the peak stage. Focal epileptiform discharges inEEG can be detected during the whole course.

关 键 词：N-甲基-D-天冬氨酸受体脑炎 脑电图 癫痫 

分 类 号：R741.044[医药卫生—神经病学与精神病学]