头皮脑电图中高频振荡在癫痫性脑病伴睡眠中持续棘慢波患儿中的应用  

Application of scalp-recorded high-frequency oscillations in epileptic encephalopathy with continuous spike-and-wave during sleep

作　　者：龚潘 杨志仙[1] 薛姣[1] 钱萍[1] 杨海坡[1] 刘晓燕[1] 边凯归 GONG Pan;YANG Zhi-xian;XUE Jiao;QIAN Ping;YANG Hai-po;LIU Xiao-yan;BIAN Kai-gui(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Institute of Network Computing and Information Systems,Peking University,Beijing 100871,China)

机构地区：[1]北京大学第一医院儿科,北京100034 [2]北京大学网络与信息系统研究所,北京100871

出　　处：《北京大学学报（医学版）》2018年第2期213-220,共8页Journal of Peking University:Health Sciences

基　　金：北京大学医学-信息科学交叉学科种子基金(BMU20160586);北京市科学技术委员会(Z171100001017125);国家自然科学基金(81771393)资助~~

摘　　要：目的:探讨头皮脑电图(electroencephalography,EEG)中高频振荡(high-frequency oscillations,HFOs)在癫痫性脑病伴睡眠中持续棘慢波(epileptic encephalopathy with continuous spike-and-wave during sleep,CSWS)患儿中的意义。方法:回顾性收集2006年1月至2016年12月在北京大学第一医院就诊的CSWS患儿21例,比较激素治疗前HFOs阳性组和HFOs阴性组以及激素冲击治疗后发作有效组和无效组间患儿的性别、特征年龄、癫痫发作频率及抗癫痫药等电临床资料,分析激素治疗前后EEG中发作间期HFOs和棘波出现情况。结果:激素治疗前,21例患儿中有12例(57%)EEG中记录到HFOs,每人平均43.17/60 s。HFOs阳性组较HFOs阴性组激素治疗前1个月负性肌阵挛/失张力/肌阵挛/不典型失神发作更频繁(P=0.004)。激素治疗前,共检测到518个HFOs和22 592个棘波,441个(86%)HFOs复合于棘波,且HFOs和棘波的最大波幅呈正相关性(r=0.279,P<0.001)。激素治疗后,HFOs(P=0.002)和棘波(P=0.006)均显著减少,减少的百分比分别为91%(473/518)和39%(8 905/22 592)。13例(62%)激素治疗后3个月内无发作(有效组),另8例仍有发作或复发(无效组)。激素治疗后,有效组HFOs出现率减少100%,棘波减少47%;治疗无效组HFOs出现率减少79%,棘波增加14%。结论:HFOs可在一定程度上反映癫痫发作严重程度,且对激素治疗较棘波更加敏感,与癫痫发作控制密切相关,可用于评估癫痫严重程度和治疗疗效。Objective:To investigate the clinical significance of high-frequency oscillations(HFOs)on scalp electroencephalography(EEG)in patients with epileptic encephalopathy with continuous spikeand-wave during sleep(CSWS).Methods:Twenty-one CSWS patients treated for epilepsy from January 2006 to December 2016 in Pediatric Department of Peking University First Hospital were enrolled into the study.Selected clinical variables including gender,age parameters,seizure frequencies and antiepileptic drugs were compared between(a).HFO-positive group and HFO-negative group before methylprednisolone treatment and(b).excellent seizure outcome group and not-excellent seizure outcome group after methylprednisolone treatment.Interictal HFOs and spikes in pre-and post-methylprednisolone scalp EEG were measured and analyzed.Results:Before methylprednisolone treatment,there were 12 of 21(57%)CSWS patients had HFOs,with a mean value 43.17 per 60 s per patient.The 12 patients with HFOs tended to have more frequent epileptic negative myoclonus/atonic/myoclonus/atypical absences than those without HFOs in a month before methylprednisolone treatment.A total of 518 HFOs and 22 592 spikes were found in the pre-methylprednisolone EEG data of 21 patients,and 441 HFOs(86%)were associa-ted with spikes.The highest amplitudes of HFOs were significantly positively correlated with that of spikes(r=0.279,P<0.001).Rates reduced by methylprednisolone treatment were statistically significant for both HFOs(P=0.002)and spikes(P=0.006).The percentage of reduction was 91%(473/518)and 39%(8 905/22 592)for spikes and HFOs,respectively.The percentage of spike and HFOs changes was respectively 100%decrease and 47%decrease in the excellent seizure outcome group,and they were 79%decrease and 18%increase in the not-excellent seizure outcome group.Conclusion:Prevalence of HFOs might reflect some aspect of epileptic activity.HFOs were more sensitive to methylprednisolone treatment than spikes and had a good correlation with the prognosis of seizures,and HFOs could be a

关 键 词：高频振荡 癫痫性脑病伴睡眠中持续棘慢波 头皮脑电图 时频分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]