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Analysis of EEG among 2 357 healthy people in Beijing area

ObjectiveNumerous foreign researches focused on the changes of EEG during the developmental periods from the newborn to late adulthood. However, the EEG changes of healthy Chinese people is still rare. Therefore, we examined the EEG of 2 357 healthy Chinese people.MethodsIn 1982, guided by Prof. Feng, we analysed the waking EEG of 2 357 healthy people, from 2 to above 60 years old, including open eyes induction test and hyperventilation.ResultsAt age 2 ~ 4, the posterior basic rhythms has reached 8 ~ 9 Hz, but the rhythms were unregular pattern. After age 7, the rhythms were 9 Hz, α index was more than 60%, the amplitude was higher than other ages. At age 12 ~ 14, the main rhythms was 10 Hz, the same as adulthood, α index was 70% ~ 80%. After this age, the amplitude of α rhythm deceased gradually. Above 60 years old, the main rhythm was 9 Hz, α index <60%, the amplitude was lower than adulthood. At age 14 ~ 16, the θ index in frontal and temporal regions was 6%, the same as the adulthood. At age 18 ~ 20, β index was 20%.ConclusionsIn the article, we analyzed the waking EEG of 2 357 healthy Chinese people in Beijing area. Although this multi-center study was accomplished at 1980s, the data is still of great value to the clinical EEG today.

癫痫实用性临床定义

2005年的癫痫概念性定义:一种具有持久性产生癫痫样发作倾向的大脑疾患。实际上,这个定义通常用于间隔24 h以上的两次非诱发性痫性发作。国际抗癫痫联盟(ILAE)接受了一个特别工作组的建议,在没有满足两次非诱发性发作标准的特殊情况下,改变了实用性定义。特别工作组建议,在符合下列任何一项条件时,癫痫可以考虑为一种脑部疾病:①至少两次间隔>24 h的非诱发性(或反射性)痫性发作;②一次非诱发性(或反射性)痫性发作,在未来10年内,再次发作的可能性与两次非诱发性发作后的再发可能性相当(至少60%);③癫痫综合征的诊断,具有年龄相关的癫痫综合征的个人,目前已经超过该患病年龄,或保持无发作至少10年,并停用抗癫痫药物至少5年,这类癫痫被认为是可以解除的。"解除"与传统上"缓解"或"治愈"的观点不同。不同的实用性定义的形成服务于各种不同的目的。这次修订癫痫定义所使用的术语与常用的术语一致。

The role of magnetoencephalography in presurgical focus localization in epilepsy

Intracranial electrographic recording, especially stereoencephalography (SEEG), remains the gold standard for preoperative localization in epilepsy patients. However, this method is invasive and has low spatial resolution. In 1982, magnetoencephalography (MEG) began to be used in epilepsy clinics. MEG is not affected by the skull and scalp, can provide signals with high temporal and spatial resolution, and can be used to determine the epiletogensis zone (EZ) and the seizure onset zone (SOZ). Magnetic source imaging (MSI) is a method that superimposes the MEG data on a magnetic resonance image (MRI) and has become a major tool for presurgical localization. The applicability of MEG data has been largely improved by the development of many post-MRI processing methods in the last 20 years. In terms of the sensitivity of localization, MEG is superior to VEEG, MRI, PET and SPECT, despite inferiority to SEEG. MEG can also assist in the intracranial placement of electrodes and improve preoperative planning. Limitations of MEG include high cost, insensitivity to radiation source, and difficulty in locating deep EZ in the medial regions of the brain. These limitations could be overcome by new generations of equipment and improvement of algorithmics.

强制正常化（Forced normalization）—一种特殊的发作，脑电图和精神病的相关性

癫痫发作和精神症状之间有拮抗现象，即发作消失及脑电图明显改善后出现精神症状，1953 年 Landolt 称之为强制正常化（Forced normalization）。至今报道尚不多。机制仍待研究。可能诱因为抗癫痫药物或癫痫外科治疗，尤其是颞叶切除。应用抗精神病药物后大多数精神症状消失，如不积极治疗可能成为持续性精神症状。因此值得重视。

穿透征（Transmantle sign）的磁共振成像及其特征

Barkovich等于1997年首先报道磁共振成像的穿透征，在T2相FLAIR相为轻度高信号，T1相为低信号的带状异常从异常脑沟伸延至侧脑室壁。最常见于局限性皮质发育障碍 Ⅱb 型。本文复习相关文献介绍其磁共振成像特点、定义、临床意义及组织病理学，结合发生机制强调穿透征的必要条件为从皮质沟底伸向侧脑室壁的异常信号，不能与同样常见于局限性皮质发育障碍 Ⅱ 型的沟底现象混为一谈。

癫痫内科医生在癫痫术前评估中应具备的条件和应起的作用

顶叶外侧癫痫—解剖、生理与临床

顶叶为联合皮质与其他脑叶有广泛的联系。顶叶癫痫少见仅为全部癫痫的1.4%。因其无特殊性症状且迅速扩布至其他脑叶，所以发作症状复杂，临床诊断困难。具有躯体感觉、体象障碍、前庭感觉这三种先兆，发作源于顶叶的可能性非常大。发作性症状多类似额叶或颞叶发作。头皮脑电图定位意义不大，因此多需要颅内电极监测以及影像学［如磁共振成像（Magnetic resonance imaging， MRI），发作时单光子发射计算机断层成像术（Single-photon emission computed tomography，SPECT）］检测。顶叶癫痫几乎均为药物难治性发作，定位明确的外科治疗60%～80%预后良好。

在常规表面电极脑电图检测中慎用“表面蝶骨电极”

轻度皮质发育畸形伴少突胶质细胞增生及癫痫（MOGHE）—一个新的临床组织病理学实体

2002年Burger等首先报道癫痫患者的大脑标本中有少突胶质细胞增生。2013年Coras等认为是一个新的临床病理学实体称之增殖性少突胶质细胞伴癫痫（Proliferative oligodendroglial hyperlasia in epilepsy，POGHE）。2017年Schurr等详细研究其病理学后确认为轻度皮质发育畸形伴少突胶质细胞增生及癫痫（Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy，MOGHE）。迄今国外文献报道92例，国内尚无报道及介绍，本文对92例进行分析并复习文献。均为儿童药物难治性部分发作，发作年龄≤15岁者96.4%，≤10岁者83.1%。临床表现多种多样。电临床多定位于额叶（81.5%），少数在颞顶或颞枕区。磁共振成像异常类似于局灶性皮质发育不良（Focal cortical dysplasia，FCD），尤其是FCDⅡa。均为药物难治性癫痫，并做外科切除性治疗。组织病理学均有不同于FCD的特点，即灰白质交界处有簇状或层状少突胶质细胞增生及异位神经元。但皮质分层无异常。

双侧颞叶癫痫

颞叶癫痫（Temporal lobe epilepsy，TLE）是最常见的限局性癫痫，药物治疗效果差，因此是癫痫外科治疗的主要类型。但标准前颞切除后 1～2 年无发作率仅为 65%，其原因之一是双侧颞叶癫痫（Bilateral temporal lobe epilepsy，BTLE）。BTLE 的定义尚无统一标准，在临床及头皮脑电图可发现有 BTLE 的可能，颅内电极尤其是立体定向脑电图在确定 BTLE 方面起决定性作用。BTLE 的确切发生率尚不了解，在 TLE 大约 30%～40% 为 BTLE。双侧颞叶间有功能性相互密切联系，一侧颞叶病变或功能异常很容易影响对侧颞叶，逐渐形成 BTLE。BTLE 几乎均为药物难治的，在精准定位定侧的情况下，如能证实发作的 50%～80% 以上起于一侧，神经心理检查对侧颞叶功能适当，无颞外症状，行一侧颞叶切除 30% 预后好。对 BTLE 尚有很多需深入研究的问题，尤其是外科治疗的适应证及预后。今后应深入开展多中心大样本前瞻性研究。