1、顳葉癲癇的發(fā)作期腦電圖特點(diǎn),SAFE CLUB 2016-1-8 王靜,發(fā)作期頭皮腦電圖表現(xiàn)形式,1、節(jié)律范疇的放電活動(dòng)； 2、突發(fā)性快活動(dòng)：放電頻率13Hz； 3、抑制現(xiàn)象：放電活動(dòng)的波幅10v； 4、可重復(fù)性癲癇式樣放電：連續(xù)出現(xiàn)3個(gè)或3個(gè)以上的放電； 5、不規(guī)則放電：波形不規(guī)則、復(fù)合頻率的放電； 6、偽跡干擾：癲癇式樣的放電被偽跡干擾，難于判斷起始時(shí)間、形態(tài)和分布。,N. Foldvary; G. Klem, REEGT; J. Hammel; W. Bingaman; I. Najm; and H. Lders. The localizing value of ictal EEG in

2、 focal epilepsy NEUROLOGY 2001;57:20222028,顳葉起始的發(fā)作期頭皮腦電圖特點(diǎn),、節(jié)律范疇的放電活動(dòng) 突發(fā)性快活動(dòng) 可重復(fù)性癲癇式樣放電 局灶性或廣泛性電位低減或低平,顳葉起始的發(fā)作期頭皮腦電圖特點(diǎn),顳葉內(nèi)側(cè)型癲癇發(fā)作起始放電： 最常見(jiàn)的表現(xiàn)形式為或節(jié)律范疇(59Hz)的放電活動(dòng)（74-83%發(fā)作）； 發(fā)作起始無(wú)側(cè)向性或彌漫性，可出現(xiàn)后續(xù)局灶顯著性放電（82-92%發(fā)作），常表現(xiàn)為節(jié)律性棘波；后續(xù)局灶性放電出現(xiàn)在發(fā)作起始后30s之內(nèi)，認(rèn)為具有定側(cè)/定位意義，一般與發(fā)作起始的平均間隔時(shí)間為12.613.3s。,Ekaterina Pataraia, Stef

3、anie Lurger, *Thomas Czech, *Klaus Novak, Liider Deecke, Christoph Baumgartner et al. Ictal Scalp EEG in Unilateral Mesial Temporal Lobe Epilepsy Epilepsia, 39(6):608-614, 1998,顳葉起始的發(fā)作結(jié)束后放電特點(diǎn)：,Mohammed M.S. Jan The value of postictal electroencephalogram in temporal lobe seizures Annals of Saudi Med

4、icine, Vol 19, No 6, 1999,發(fā)作結(jié)束后腦電圖是指發(fā)作期節(jié)律性放電活動(dòng)消失； 發(fā)作結(jié)束后腦電圖異常通常表現(xiàn)為節(jié)律的活動(dòng)（頻率：1-3Hz，波幅是發(fā)作前背景活動(dòng)波幅的50%以上）； 顳葉起始的發(fā)作，發(fā)作結(jié)束后活動(dòng)出現(xiàn)的意義：?jiǎn)渭儾糠中园l(fā)作（55%），復(fù)雜部分性發(fā)作（85%），繼發(fā)全身強(qiáng)直-陣攣發(fā)作（100%）；常位于發(fā)作期癲癇放電最明顯的部位，提示癲癇發(fā)作起始同側(cè)半球。,發(fā)作期顱內(nèi)電極腦電圖特點(diǎn),P. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset pa

5、tterns: effect of underlying pathology Brain 2014:137;183-196,1.Low-voltage fast activity, clearly visible rhythmic activity13Hz (Spanedda et al.,1997;Lee et al., 2000;Wennberg et al., 2002), usually 5s (Spencer et al., 1992a; Velasco et al., 2000; Bartolomei et al., 2004) 3.Sharp activity at =13Hz,

6、 low- to medium-voltage sharply-contoured rhythmic activity (Wennberg et al., 2002), most commonly in the alpha-theta range (Spanedda et al.,1997; Schiler et al., 1998) 4.Spike-and-wave activity, medium- to high- voltage spike-and-wave complexes typically occurring at a frequency of 2-4Hz (Wennberg

7、et al., 2002) 5.Burst of high-amplitude polyspikes, a single brief burst of repetitive high-voltage spikes(Faught et al., 1992),6.Burst suppression, brief bursts of medium- to high- voltage repetitive spikes alternating with brief periods of voltage attenuation 7. Delta brush, rhythmic delta waves a

8、t 1-2Hz, with superimposed brief bursts of 20-30Hz activity overriding each delta wave.(premature infants-Clancy et al., 2003; anti-NMDA receptor encephalitis-Schmitt et al., 2012),P. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset patterns: effect of underlying

9、pathology Brain 2014:137;183-196,Each pattern occurred across several pathologies (mesial temporal sclerosis ,focal cortical dysplasia, cortical atrophy. Periventricular nodular heterotopia, polymicrogyria and tuberous sclerosis complex) Periodic spikes only observed with mesial temporal sclerosis D

10、elta brush exclusive to focal cortical dysplasia,Seizure-onset patterns,P. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset patterns: effect of underlying pathology Brain 2014:137;183-196,Seizure-onset patterns in regions of seizure spread,Sharp activity at =13Hz

11、Low-voltage fast activity (all epileptogenic lesions) Spike-and-wave activity (only in mesial temporal atrophy/sclerosis and FCD) Low-frequency high-amplitude periodic spikes (only in mesial temporal atrophy/sclerosis) -慎用發(fā)作起始的波形特點(diǎn)判斷致癇區(qū),P. Perucca, F. Dubeau and J. Gotman. Intracranial electroenceph

12、alographic seizure-onset patterns: effect of underlying pathology Brain 2014:137;183-196,High-frequency oscillations, independently of the pattern,Fast ripples: low-voltage fast activity, low-frequency high-amplitude periodic spikes, burst of high-amplitude polyspikes delta brush Ripples: sharp activity at =13Hz spike-a