癫痫不明原因猝死的临床和神经电生理研究  

The clinical and neuroelectrophysiological characteristics of patients with sudden unexpected death in epilepsy

作　　者：安文娜 石晓丹 王碧 王晓丽 王则直 张歆博 王钦鹏[2] 朱江 刘永红 An Wenna;Xiaodan Shi;Wang Bi;Wang Xiaoli;Wang Zezhi;Zhang Xinbo;Wang Qinpeng;Zhu Jiang;Liu Yonghong(Department of Neurology,Xijing Hospital,the Air Force Military Medical University,Xi′an 710032,China;Department of Neurology,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]空军军医大学西京医院神经内科,西安710032 [2]兰州大学第二医院神经内科,兰州730030

出　　处：《中华神经科杂志》2023年第6期679-685,共7页Chinese Journal of Neurology

基　　金：国家重点研发计划(2022YFC2503806);航空医学重大课题(2019ZTB03,2020JSTS21);陕西省重点研发计划(2023-YBSF-199)。

摘　　要：目的探讨癫痫不明原因猝死(SUDEP)患者的临床及电生理特点。方法以“癫痫”作为关键词,在空军军医大学西京医院脑电监测中心数据库中检索2011年10月至2012年3月录入的相关病例。对所有确诊的癫痫患者进行电话随访,对于电话随访确认的死亡病例,结合其既往病史、临床资料、死亡细节等,将确定符合SUDEP诊断的患者纳入本研究,并对其临床和神经电生理特征进行总结分析。结果在1232例癫痫患者中,成功回访354例癫痫患者,其中死亡患者17例(4.8%),SUDEP患者12例。在12例SUDEP患者中,男性7例,女性5例。9例患者的病程持续时间超过10年。8例患者表现为局灶继发双侧强直阵挛发作。9例为单药治疗。12例患者共行13次24 h视频脑电图监测(其中1例患者行2次脑电图监测),结果均显示异常;有8次脑电图枕导α背景节律较同龄人标准频率减慢或以慢波为主,12次脑电图存在颞导的发作间期癫痫样放电(IED),9次合并额导IED。其中在1例患者间隔6年的2次脑电图检查中发现,第2次视频脑电图背景节律较首次明显减慢、IED范围扩大。在复查脑电图后的第3年,该例患者发生SUDEP。结论SUDEP患者均有较长的病程及双侧强直阵挛发作,发作间期脑电图可见枕导慢α活动及颞额导癫痫样放电,可能会增加发生SUDEP的风险。Objective To investigate the clinical and electrophysiological characteristics of patients with sudden unexpected death of epilepsy(SUDEP).Methods Using"epilepsy"as the keyword,the relevant cases entered from October 2011 to March 2012 were searched in the database of the Electroencephalogram(EEG)Monitoring Center,Xijing Hospital,the Air Force Military Medical University.Telephone follow-up was conducted for all confirmed epilepsy patients,and for the death cases confirmed by telephone follow-up,the patients identified as consistent with SUDEP diagnosis were included in this study based on their past medical history,clinical data,death details,etc,and their clinical and neuroelectrophysiological characteristics were summarized and analyzed.Results Among the 1232 patients who underwent 24-hour video-EEG monitoring during the study period,354 patients were successfully followed up by telephone interview,of whom 17 patients were died(4.8%),12 individuals met the diagnosis of SUDEP(7 men,5 women).The duration of the disease in 9 patients exceeded 10 years.Eight cases presented with focal-bilateral tonic clonic seizures.Nine patients were treated with anti-seizure drug monotherapy.All the 24-hour video EEG of 12 patients were abnormal.There were 8 occasions when the EEG occipitalαbackground rhythm slowed down compared with the standard frequency of peers or was dominated by slow waves.Interictal epileptic discharge(IED)located in temporal lobe were found in 12 EEG records,of which 9 EEG records were found with frontal IED.One of the 12 cases received 24-hour video EEG twice within 6 years,and his EEG background rhythm was significantly slower and the IED region was expanded compared with the first EEG record.At the third year after reexamination of EEG,SUDEP developed in this patient.Conclusions SUDEP patients have a long course of disease and bilateral tonic-clonic seizure.The interictal EEG shows occipital slowαactivity and temporofrontal epileptiform discharges,which may increase the risk of SUDEP.

关 键 词：癫痫 猝死 癫痫 强直阵挛性 脑电描记术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]