头皮脑电图波型对动脉瘤性蛛网膜下腔出血继发癫痫的预测价值  

Predictive value of scalp electroencephalogram patterns for secondary epilepsy after aneurysmal subarachnoid hemorrhage

作　　者：廖兴甫 但炜[1] 孙超[1] 朱黎 陶园 石全红[1] 詹彦[1] 孙晓川[1] 谢延风[1] LIAO Xingfu;DAN Wei;SUN Chao;ZHU Li;TAO Yuan;SHI Quanhong;ZHAN Yan;SUN Xiaochuan;XIE Yanfeng(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

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》2018年第15期1383-1388,共6页Journal of Third Military Medical University

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

摘　　要：目的分析动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)头皮脑电图(electro-encephalogram,EEG)的特点,比较EEG不同波形特征与a SAH继发癫痫的关系,探讨头皮脑电图波型对a SAH后癫痫发生的预测价值。方法回顾性分析我院神经外科2014年1月至2017年1月312例a SAH患者脑电图资料,出院后平均随访半年以上。按照有无癫痫发作分为:发作组和非发作组。按癫痫发生时间分为早期癫痫组和晚期癫痫组。将头皮脑电图波形分为:Ⅰ型(正常脑电图)、Ⅱ型(慢波类型)、Ⅲ型(爆发性慢波类型)、Ⅳ型(典型棘尖波类型)和Ⅴ型(电发作类型),分别比较各组的头皮脑电图波形特征。结果 (1)312例a SAH患者中有44例诊断为癫痫,其癫痫发生率为14.1%,其中早期癫痫24例(7.7%),晚期癫痫20例(6.4%)。(2)发作组和非发作组患者脑电图类型构成比差异存在统计学意义(P<0.01)。发作组中脑电图类型以Ⅲ型和Ⅳ型为主(84.1%),非发作组以Ⅱ型为主(79.5%)。发作组中,Ⅲ型、Ⅳ型和Ⅴ型的比例(95.5%)显著高于非发作组(19.0%)。(3)早期癫痫组和晚期癫痫组患者脑电图类型构成比差异存在统计学意义(P<0.01),早期癫痫组以Ⅲ型最多(70.8%),晚期癫痫组以Ⅳ型最多(80.0%)。结论头皮脑电图对动脉瘤性蛛网膜下腔出血继发癫痫有一定的预测价值,Ⅲ型、Ⅳ型和Ⅴ型为a SAH继发癫痫的高危波型;Ⅲ型、Ⅳ型可能分别与早、晚期癫痫有关。Objective To analyze the characteristics of scalp encephalogram （EEG） in the patients of aneurysmal subarachnoid hemorrhage （aSAH）, compare the relationship of different brain wave patterns with secondary epilepsy after aSAH, and assess the predictive value of EEG pattems for epilepsy. Methods A retrospective study was performed on the EEG data of 312 aSAH patients admitted in our department from January 2014 to January 2017. All patients were followed up for over half a year. According to the presence of epileptic seizures, the patients were divided into seizures and non-epileptic seizure groups. The former group were also assigned into early epileptic group and late epileptic group based on the time of seizure. The EEG morphological patterns were divided into type Ⅰ （normal EEG） , type Ⅱ （slow wave type） , type Ⅲ （explosive slow wave type）, type IV （typical spikes sharp wave type）, and type Ⅴ （eleetrographic seizure）. The EEG patterns were compared in different groups. Results （1） In the 312 aSAH patients, there were 44 patients with epilepsy, with an incidence rate of 14.1% , including 24 cases （7.7%） of early epilepsy and 20 cases of advanced epilepsy （6.4%）. （2） There were significant differences in the EEG patterns between the seizures group and the non-epileptic seizure group （P 〈 0.01 ）. The main EEG pattern was type Ⅲ and type Ⅳ in the seizures group （84.1% ）, and type Ⅱin the non-epileptic seizure group （79.5 % ）. The proportion of types Ⅲ,Ⅳ and V was significantly higher in the seizures group （95.5 % ） than the non-epileptic seizure group （19.0%）. （3） There were significant differences in the EEG patterns between the early and late epilepsy groups （P 〈0.01 ）. Type Ⅲ was the most frequent type in the early epilepsy group （70.8%）, and type Ⅳ was in the late epilepsy group （ 80.0% ）. Conclusion Scalp electroencephalogram has a certain predictive value for secondary epilepsy after aneurysmal subarac

关 键 词：头皮脑电图 癫痫 动脉瘤性蛛网膜下腔出血 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.41[医药卫生—临床医学]