25导脑电系统在检测癫痫患者颞区痫样放电中的应用研究  

Clinical application of the 25 electrodes electroencephalogram system in detecting temporal epileptiform discharges in patients with epilepsy

作　　者：冯宇 张倩倩 吕敏之 吴魁东 张一君 毛玲艳 丁晶 汪昕 Feng Yu;Zhang Qianqian;Lyu Minzhi;Wu Kuidong;Zhang Yijun;Mao Lingyan;Ding Jing;Wang Xin(Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Biostatistics,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院神经内科,上海200032 [2]复旦大学附属中山医院生物统计室,上海200032

出　　处：《中华神经科杂志》2021年第1期9-15,共7页Chinese Journal of Neurology

基　　金：上海市科学技术委员会医学引导项目(17411962500)。

摘　　要：目的比较2017年国际临床神经生理学联盟提出的25导脑电系统与既往19导脑电系统在癫痫患者痫样放电的检出能力方面的差异。方法收集2018年3月至2019年11月复旦大学附属中山医院门诊拟诊癫痫或已确诊癫痫需随访脑电图检查者,行25导连续视频脑电图检查2 h。由2名脑电报告医师盲法读图,标记两种脑电系统记录到的痫样放电及波幅,最后对数据进行统计分析。结果共纳入403名受检者,最终临床确诊癫痫患者263例,其中全面性癫痫129例、颞叶癫痫115例、额叶癫痫13例、顶叶癫痫2例、枕叶癫痫4例。在115例颞叶癫痫患者中,25导脑电系统检测到有痫样放电者100例(86.96%),较19导脑电系统检测到有痫样放电者76例(66.09%)显著增多(χ^(2)=13.939,P<0.001)。在非颞叶癫痫患者中,两系统检测结果差异无统计学意义。在两系统共同检测出有痫样放电的76例颞叶癫痫患者中,新增颞叶电极(F9/F10、T9/T10、P9/P10)记录的颞区痫样放电波幅[(61.53±22.64)μV]较原颞叶电极(F7/F8、T7/T8、P7/P8)所记录的波幅[(48.25±20.90)μV]显著增高(t=5.486,P<0.001)。在影像学异常[79.59%(39/49)比61.22%(30/49),χ^(2)=3.967,P=0.046]及无异常[95.45%(42/44)比70.45%(31/44),χ^(2)=9.724,P=0.003]的颞叶癫痫患者中,25导脑电系统对痫样放电的检出能力都较19导脑电系统显著增高。结论25导脑电系统可显著提高癫痫患者颞区痫样放电检出能力,推荐临床常规应用以增强颞区异常波的检测能力,更好地辅助癫痫诊疗。Objective To compare the difference of epileptiform discharges detection in patients with epilepsy between the 25 electrodes electroencephalogram(EEG)system proposed by the International Federation of Clinical Neurophysiology in 2017 and the previous 19 electrodes EEG system.Methods Patients suspected of epilepsy or with confirmed epilepsy who need a follow-up EEG were collected in Zhongshan Hospital,Fudan University from March 2018 to November 2019,and conventional video-EEG recording was performed on all patients for two hours with the standard 25 electrodes EEG system.Two neurophysiologists reviewed the recordings blindly using the 19 electrodes system and the 25 electrodes system,marking the epileptiform discharges and their amplitudes.Finally,the data were statistically analyzed.Results A total of 403 patients were included in the study,in which 263 cases were diagnosed as epilepsy,including 129 cases of generalized epilepsy,115 cases of temporal lobe epilepsy,13 cases of frontal lobe epilepsy,two cases of parietal lobe epilepsy and four cases of occipital lobe epilepsy.In 115 temporal lobe epilepsy patients,76(66.09%)and 100(86.96%)records were detected epileptiform discharges by the 19 or 25 electrodes EEG system respectively,and the difference was statistically significant(χ^(2)=13.939,P<0.001).While in patients with non-temporal lobe epilepsy,there was not statistically significant difference between the two systems.In 76 patients whose temporal epileptiform discharges were detected by the two systems,the amplitudes of epileptiform discharges in the newly-added inferior temporal electrodes(F9/F10,T9/T10,P9/P10)and the original temporal electrodes(F7/F8,T7/T8,P7/P8)were(61.53±22.64)μV and(48.25±20.90)μV,respectively,with statistically significant difference between the two groups(t=5.486,P<0.001).In patients with abnormal[79.59%(39/49)vs 61.22%(30/49),χ^(2)=3.967,P=0.046]and normal[95.45%(42/44)vs 70.45%(31/44),χ^(2)=9.724,P=0.003]imaging,the ability of the 25 electrodes EEG system to detect epilep

关 键 词：癫痫 癫痫 颞叶 头皮脑电图 10-20系统 10-10系统 

分 类 号：R742.1[医药卫生—神经病学与精神病学]