【摘要】 目的 探讨用视频脑电图和MRI诊断药物难治性癫痫的临床价值。 方法 收集2006年12月-2010年5月间经手术和病理证实的药物难治性癫痫患者38例。其中，海马硬化25例，颞叶萎缩伴脑发育不良2例，脑灰质移位及巨脑回4例，血管畸形3例，胶质瘤2例，脑内囊肿1例，外伤性癫痫1例。用视频脑电图监测癫痫发作期及发作间期痫样放电的来源部位及脑电活动特点，用MRI扫描显示痫灶区的表现特征，并与手术、病理改变对照，进行回顾性分析。 结果 视频脑电图对癫痫发作期的致痫灶来源定位准确率为100%（38/38），发作间期定位准确率为53%（20/38）。MRI对发作间期的致痫灶及相关病变定位诊断准确率为89%（34/38），病变定性准确率为79%（30/38）。 结论 视频脑电图和MRI检查有机结合，对药物难治性癫痫，能更有效检出致痫灶的部位及性质，为药物难治性癫痫患者的手术治疗，提供重要信息。【Abstract】 Objective To study the clinical diagnosis value of video-electroencephalography (EEG) and MRI on pharmacal intractable epilepsy. Methods From December 2006 to May 2010, 38 cases of pharmacal intractable epilepsy were confirmed through operation and pathologic examination. Among them, there were 25 cases of hippocampal sclerosis, 2 cases of temporal lobe atrophy combined with brain dysplasia, 4 cases of heterotopic gray matter and macrogyria, 3 cases of vascular malformation, 2 cases of glioma, 1 case of cyst in brain, and 1 case of traumatic epilepsy. Video-EEG was applied to monitor the source of epileptoid discharge and the features of brain electrical activity during and between the occurrences of epilepsy. MRI was used to detect the manifestation characteristics of the epilepsy focus, and retrospective analysis was done to compare these findings with operational and pathological results. Results The accuracy rate of Video-EEG in locating the epilepsy focus was 100% (38/38) during the occurrence of epilepsy, and 53% (20/38) between the occurrences of epilepsy. The accuracy rate of MRI in diagnosing the epilepsy focus and relevant abnormalities during the occurrence of epilepsy was 89% (34/38), and 79% (30/38) in characterizing the abnormalities. Conclusion Video-EEG combined with MRI examination is effective in locating and characterizing the epilepsy focus, which can provide more useful information for the surgery in treating pharmacal intractable epilepsy.
ObjectiveTo explore the clinical and video EEG features of patients with post-stroke epilepsy (PSE).MethodsThe clinical data of 68 patients with epilepsy after cerebral infarction and 33 patients with epilepsy after cerebral hemorrhage were analyzed retrospectively from January 2015 to June 2018 in the Affilated Hospital of Jining Medical University. There were 5 cases of early-onset epilepsy, and the rest were late-onset epilepsy. There were 68 cases of cerebral infarction (1 case showed post-infarction hemorrhagic transformation), 33 cases of cerebral hemorrhage; 51 females, 50 males (f∶m = 1.02∶1); the onset age was 45 ~ 101 years, with an average of (68.10 ± 10.26) years.ResultsThe time from seizure to stroke in 101 cases was (28.92 ± 35.61) months, 60 cases (59.40%) ≤ 1 year, 26 cases (25.74%) 1 ~ 5 years, and 15 cases (14.85%) 5 ~ 10 years. Post-stroke epilepsy had no relation to gender (P>0.05). The age of onset is mostly in 60 to 75 years old (62.38%). Seizure often happen within 1 year after stroke (59.4%). The type of attack is focal seizure (77.23%). Cortical infarction (77.94%), cerebral artery stenosis (83.82%), hypertension, diabetes, and atrial fibrillation are risk factors for epilepsy after infarction. The abnormal rate of EEG for PSE is 90.1%, which was manifested as slow wave in the lesion side, epileptic wave in the lesion side or contralateral side.ConclusionsThe location, duration, age and severity of cerebral artery stenosis in patients with PSE are closely related to the occurrence of seizure. VEEG plays an important role in the diagnosis, treatment and prognosis of epilepsy.
ObjectiveTo explore the technique of preoperative evaluation of video electroencephalography (VEEG) electrode fixation method.MethodsThe electrode fixation method was modified using a simple and easy-to-manufacture 3M decompression sticker designed by ourselves.ResultsUsing the modified electrode fixation method, compared with the traditional fixation method, the electrode displacement, shedding rate and pain score of the children were significantly lower (P<0.05). The incidence of skin pressure sore by traditional fixation method was 7.03%. The rate of improvement after release was 3.37%. Although it was not statistically significant, the incidence of pressure ulcers were reduced.ConclusionsEffectively reduce the adverse reactions such as electrode displacement, shedding, pain and skin pressure sore caused by wearing the electrode for a long time. It has the advantages of being simple, fast, safe, stable and humanized, and it is worthy of clinical promotion.
【摘要】 目的 分析床旁陪护行为对视频脑电图的影响，总结护理指导的意义。 方法 2008年7-9月对214例患者行24 h视频脑电图监测（video EEG，VEEG）监测，每例患者留一床旁陪护。重点观察坐床沿或同睡、用手机、拍打及按摩行为，并比较初次及再次护理指导后上述行为发生情况。 结果 坐床沿或同睡、用手机、拍打、按摩均可影响VEEG，初次指导后以上行为出现率分别为62.6%、55.1%、30.4%、20.1%；再次指导后以上行为分别减少78.4%、75.4%、78.5%、79.1%，VEEG监测质量均有提高。 结论 应将规范床旁陪护行为的指导贯穿于VEEG监测的全过程。【Abstract】 Objective To assess the impacts of bedside accompany behavior on the quality of video-electroencephalography (VEEG). Methods A total of 214 patients underwent 24-hour VEEG monitoring from July to September 2008. Each patient had a bedside-accompany family member. The behaviors of accompany included sitting at the bed, using mobile phone, clapping, and kneading the patients, which were evaluated after the first and second nursing education. Results Sitting at the bed, using mobile phone, clapping, and kneading the patients influenced the quality of VEEG. After the first education, the occurrences of the above unfavorable behaviors were 62.3%, 55.1%, 30.4%, and 20.1%. After the second education, the unfavorable behaviors reduced 78.4%, 75.4%, 78.5%, and 79.1% respectively; the VEEG quality improved. Conclusion Proper bedside accompany behavior may improve the quality of VEEG monitoring.
ObjectiveAicardi and Goutières syndrome was first reported as a rare hereditary encephalopathy with white matter involvement in 1984. Typical clinical manifestations include severe mental motor development retardation or regression, pyramidal and extrapyramidal symptoms and signs, epilepsy, microcephaly and frostbite.MethodsTo collect a case of patient who presented with convulsions 14 days after birth without obvious inducement. The child was diagnosed as epilepsy in the local hospital and the symptoms improved after treatment with antiepileptic drugs. At 4 months, the child presented nods and clenched fists, and was diagnosed as infantile spasm. After Adrenocorticotrophic hormone and drug treatment, the symptoms gradually improved. Due to upper respiratory track infection, the child was aggravated at the age of 1 year and 2 months, and then diagnosed as Aicardi-Goutières syndrome by video EEG, skull MRI, fundus and gene screening.ResultsSurgery and treatment with antiepileptic drugs significantly improved the symptoms of the child, and the pathological biopsy of the brain tissue supported the previous diagnosis.ConclusionsThe report of this case will help to improve the clinician's diagnosis and treatment of Aicardi-Goutières syndrome.
ObjectiveTo explore the clinical value of video-electroencephalograph (VEEG) for non-epileptic seizures disease in children. MethodsThe clinical data of 58 children with non-epileptic seizures (NES) diagnosed by VEEG from October 2010 to November 2012 were retrospectively analyzed. ResultsIn 50 out of 58 patients in the process of monitoring,the NES clinical onset was found while no synchronized epileptiform discharges was observed;in five patients with NES combined with epilepsy,no epileptiform discharges was found by VEEG at the clinical onset of NES;there were 3 patients with epileptiform discharges without seizures,who had no history of epilepsy,but non-synchronized clinical nonparoxysmal epileptiform discharges was found by VEEG monitoring. ConclusionVEEG is an effective diagnosis method for NES and seizures in children,which could be regarded as the gold standard for NES diagnosis.
ObjectiveVideo electroencephalography (VEEG) monitoring for health education of elderly patients based on a process-based communication model, and explore the impact of this model on the success rate, negative emotions, nursing satisfaction, and active cooperation rate of such patients.MethodsFrom September 2017 to September 2019, 118 patients with suspected epilepsy, encephalitis and other diseases who required VEEG monitoring in Suining Central Hospital were selected for this study (patients aged 61 to 73 years; 54 males and 64 females). Patients were divided into 2 groups using a random number table method, 59 patients in each group.A group received routine nursing, and B group received health education based on the process communication model. The monitoring success rate, negative emotion, active cooperation rate, and nursing satisfaction were compared between the two groups.ResultsThe total effective rate in the B group was 86.44%, which was significantly higher than 76.27% in the A group (P<0.05). After nursing intervention, the scores of anxiety and depression in the two groups were significantly decreased, but the decline was greater in the B group (P<0.05). The active cooperation rate and nursing satisfaction of the B group were significantly higher than those of the A group (P<0.05).ConclusionCompared with conventional nursing, health education based on process communication mode can significantly improve the success rate of VEEG monitoring in elderly patients, alleviate the negative emotions of patients, improve the active cooperation rate and nursing satisfaction.
Objective To explore the actual experience of epileptic patients in video electroencephalogram (VEEG) examination, and to provide reference basis for formulating corresponding nursing strategies and coping methods. MethodsIn this descriptive analysis study, 18 patients (11 males and 7 females, average age 37.78±18.7 years) receiving VEEG from January to April 2022 in the Second Affiliated Hospital of Guangzhou Medical University, underwent a semi-structural interview. Information obtained from the interview was analyzed using the Colaizzi 7-step method. ResultsThe actual experience of epileptic patients in video EEG examination can be summarized into two aspects: the medical experience and the need for nursing care. The medical experience includes positive and negative experience. The positive experience includes good service attitude, professional medical services, good endurance, and being hopeful. The negative experience includes a weird feeling in the head, insomnia, inconvenience in life, eye discomfort, psychological pressure, and pain. The need for nursing care includes needs for knowledge, strong needs for communicating with doctors, needs for humanistic care and female needs for female implementing the equipment. Conclusion Epileptic patients suffer from different degrees of discomfort and psychological pressure during VEEG examination. Both negative and positive experience exist. Medical staff should improve the content of nursing services according to the nursing needs of patients and provide professional VEEG examination services to patients.
ObjectiveTo explore the clinical features and EEG features of gelastic seizures, and analyze its value of lateral localization of epileptogenic area. MethodsAll patients with gelastic seizures admitted to the Sanbo Brain Hospital of Capital Medical University between January 2014 and December 2023 were reviewed and analyzed for history, symptomatology, imaging, electroencephalographic features and surgical protocols in patients who met the inclusion criteria and were followed up for at least 1 year, and surgical efficacy was assessed by using the Engel grading. ResultsA total of 51 patients with gelastic seizures were included, there were 32 (62.75%) males and 19 (37.25%) females, 21 (41.18%) with hypothalamic hamartomas (HH) and 30 (58.82%) with non-hypothalamic hamartomas. The age of onset was earlier in the HH group than in the non-HH group, with a median age of onset of 24.00 (0.00 ~ 96.00) and 78.00 (1.00 ~ 396.00) months (P<0.001). There are three types of laughter according to their characteristics: smiling or pleasant expressions, laughing out loud, crying or bitter laughter, with smiling or pleasant expressions being the most common (49.02%). Simple laughter is rare in all patients and is often accompanied by other manifestations such as autonomic symptoms, automatic movements, complex movements, and tonic seizures. Most of the HH group started with laughter whereas in the non-HH group laughter appeared mostly in the mid to late stages (P=0.007). Most of the HH group (57.14%) had preserved consciousness whereas most of the non-HH group (83.33%) had loss of consciousness (P=0.003). The interictal discharges in the HH group were mostly diffuse or multiregional, whereas those in the non-HH group were mostly regional (P=0.035). The onset of EEG during the seizure period in the HH group was mostly diffuse, whereas those in the non-HH group were mostly regional, mainly in the frontal and temporal regions, but there was no significant difference between the two groups (P=0.148). The non-HH group was mostly seen in those with definite lesions, and the most common type of lesion was FCD (focal cortical dysplasia, FCD). All patients enrolled in the group underwent surgical treatment, and stereoelectroencephalogram (SEEG) electrode implantation was performed in 13 cases in the HH group and in 17 cases in the non-HH group. 61.90% of the patients in the HH group had an Engel grade I, and 73.33% of the patients in the non-HH group had an Engel grade I. ConclusionsGelastic seizures has a complex neural network, with common causes other than hypothalamic hamartomas, and is most commonly seen in frontal or temporal lobe epilepsy, as well as in the insula or parietal lobe, with the most common type of lesion being FCD. The symptomatology, stage of onset, and electroencephalographic features of gelastic seizures can help in the differential diagnosis, and SEEG can help define the origin of the seizure and its diffusion pathway. The overall prognosis of surgical treatment was better in both the hypothalamic hamartomas and non-hypothalamic hamartomas groups.
ObjectiveTo explore the prognostic value of normal 24 hour video electroencephalography (VEEG) with different frequency on antiepileptic drugs (AEDs) withdrawal in cryptogenic epilepsy patients with three years seizure-free. MethodsA retrospective study was conducted in the Neurology outpatient and the Epilepsy Center of Xi Jing Hospital. The subject who had been seizure free more than 3 years were divided into continual normal twice group and once group according to the nomal frequence of 24 hour VEEG before discontinuation from January 2013 to December 2014, and then followed up to replase or to December 2015. The recurrence and cumulative recurrence rate of the two group after withdrawal AEDs were compared with chi-square or Fisher's exact test and Kaplan-Meier survival curve. A Cox proportional hazard model was used for multivariate analysis to identify the risk factors for seizure recurrence after univariate analysis. P value < 0.05 was considered significant, and all P values were two-tailed. Results95 epilepsy patients with cause unknown between 9 to 45 years old were recruited (63 in normal twice group and 32 in normal once group). The cumulated recurrence rates in continual two normal VEEG group vs one normal VEEG group were 4.8% vs 21.9% (P=0.028), 4.8% vs 25% (P=0.006) and 7.9% vs 25%(P=0.03) at 18 months, 24 months and endpoint following AEDs withdrawal and there was statistically difference between the two groups. Factors associated with increased risk were adolescent onset epilepsy (HR=2.404), history of withdrawal recurrence (HR=7.186) and abnormal VEEG (epileptic-form discharge) (HR=8.222) during or after withdrawal AEDs. The recurrence rate of each group in which abnormal VEEG vs unchanged VEEG during or after withdrawal AEDs was respectively 100% vs 4.92% (P=0.005), 80% vs 19.23%(P=0.009). ConclusionsContinual normal 24h VEEG twice before withdrawal AEDs had higher predicting value of seizure recurrence and it could guide physicians to make the withdrawal decision. Epileptic patients with adolescent onset epilepsy, history of seizure recurrence and abnormal VEEG (epileptic-form discharge) during or after withdrawal AEDs had high risk of replase, especially patients with the presence of VEEG abnormalities is associated with a high probability of seizures occurring. Discontinuate AEDs should be cautious.