ObjectiveTo analyze and summarize the clinical and video EEG (VEEG) characteristics of tuberous sclerosis (TSC) with epilepsy.MethodsClinical data of 30 children with TSC who met the revised diagnostic criteria of TSC in 2012 from Jan. 2016 to May 2019 in Zhengzhou Children’s Hospital were collected, including 29 children with epileptic seizures. The characteristics of skin lesions, imaging, seizures and long-term VEEG were analyzed retrospectively.ResultsThe mean age was (2.88 ± 2.64), 12 males and 18 females, 1 case of lumbar acid as the first symptom, 29 cases with epilepsy as the first symptom, the incidence of epilepsy is high, and the onset age is less than 1 year old; TSC can cause different degrees of cognitive impact; depigmentation or milk coffee spots are the most common skin changes in young children; TSC with infantile spasm has a high incidence; children younger than 10 years old may have lesions of other organs except nervous system lesions. However, the incidence of other organ lesions was relatively low. Most of TSC children with epilepsy were accompanied by abnormal EEG discharge.ConclusionThe clinical characteristics of TSC with epileptic seizures are various, and early diagnosis is of great significance.
ObjectiveTo analyze the effect of mitochondrial ultrastructural changes caused by morphine toxicity on abnormal discharge of cat cerebral cortex, and to explore the possible mechanism of brain function damage caused by morphine dependence.MethodsTwelve domestic cats were divided into control group (3 cats) and morphine exposed group (9 cats) according to the method of random number table. After the model was successfully established by the method of dose increasing, the changes of mitochondrial ultrastructure of cortical neurons were observed under the electron microscope.ResultsElectroencephalogram (EEG) monitoring in morphine exposed group showed that the cortical EEG was widely abnormal, physiological waves were reduced, and abnormal discharges were frequent. And the electron microscopy showed that the number, morphology, internal membrane structure and the inclusion body in the matrix of neurons changed in various aspects. The EEG and electron microscopy of the control group were normal.ConclusionMorphine can damage neurons in the cerebral cortex and lead to abnormal discharge, which is closely related to the ultrastructural changes of neuron mitochondria. The toxicity of morphine mitochondria can be the initial mechanism of energy metabolism dysfunction of brain cells and eventually lead to the disorder of brain electrophysiological function.
ObjectiveTo explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.ConclusionsTo the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.
ObjectiveThe purpose of the research is to study the distribution and early warning of electroencephalogram (EEG) in acute mountain sickness (AMS). MethodsA total of 280 healthy young men were recruited from September 2016 to October 2016. The basic data were collected by the centralized flow method, the general situation of the division of the investigators after the training, the Lewis Lake score, the computer self-rating anxiety scale and depression scale, and the collection of EEG. Follow up in three months. Results94 of the patients with AMS, morbidity is 33%, 21 (22.34%) of the patients are moderate to severe, 73 (77.66%) are mild, morbidity is 26.67%. The abnormal detection rate of electrogram was 7.9% (22/280), which were mild EEG, normal EEG abnormal rate was 8.6% (16/186), abnormal detection rate of mild AMS was 4.1% (3/73), and the abnormal detection rate was 14.3% (3/21) in the medium / heavy AMS. The latter was significantly different from the previous (P < 0.05). Three months follow-up of this group of patients with 0 case of high altitude disease. Conclusions The EEG in AMS is mainly a rhythm irregular, unstable, poor amplitude modulation; or two hemisphere volatility difference of more than 50% or slightly increased activity. The result is statistically significant, suggesting that EEG distributions has possible early warning of AMS.
Stereo-electroencephalography (SEEG) is widely used to record the electrical activity of patients' brain in clinical. The SEEG-based epileptogenic network can better describe the origin and the spreading of seizures, which makes it an important measure to localize epileptogenic zone (EZ). SEEG data from six patients with refractory epilepsy are used in this study. Five of them are with temporal lobe epilepsy, and the other is with extratemporal lobe epilepsy. The node outflow (out-degree) and inflow (in-degree) of information are calculated in each node of epileptic network, and the overlay between selected nodes and resected nodes is analyzed. In this study, SEEG data is transformed to bipolar montage, and then the epileptic network is established by using independent effective coherence (iCoh) method. The SEEG segments at onset, middle and termination of seizures in Delta, Theta, Alpha, Beta, and Gamma rhythms are used respectively. Finally, the K-means clustering algorithm is applied on the node values of out-degree and in-degree respectively. The nodes in the cluster with high value are compared with the resected regions. The final results show that the accuracy of selected nodes in resected region in the Delta, Alpha and Beta rhythm are 0.90, 0.88 and 0.89 based on out-degree values in temporal lobe epilepsy patients respectively, while the in-degree values cannot differentiate them. In contrast, the out-degree values are higher outside the temporal lobe in the patient with extratemporal lobe epilepsy. Based on the out-degree feature in low-frequency epileptic network, this study provides a potential quantitative measure for identifying patients with temporal lobe epilepsy in clinical.
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.
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.
Objective To investigate the clinical and EEG characteristics, therapeutic response and prognosis in children with atypical absence seizures. Methods The clinical and EEG data of 43 children with atypical absence seizures in Qilu Hospital, Shandong University during January 2011 to December 2016 were analyzed, and therapeutic response and prognosis were followed up. Results Childre were 24 male and 19 female with the mean age of 5.43 y. The onset ages were from 1 years and 8 months to 10 years and 3 months. All of the 43 patients had MRI examines, and 18 children were normol. MRI abnormalities appeared in 25 children, including cerebral cortical dysplasia and cerebral atrophy (13 cases), congenital corpus callosum hypoplasia (2 cases), and abnormal signal in bilateral posterior putamen (2 cases), encephalomalacia focus(4 cases), ventricle expention (2 cases), hydrocephalus(2 cases). All the children underwent EEG more than once. All children had atypical absence seizures during daytime. Children had slowly backgrounds in retesting EEG, and spine and slow waves of 1.5 Hz to 2.8 Hz could be seen in all the atypical absence seizures. All children were followed up, and except 6 children with complete control, 19 children’ parents reported seizure- free, 18 children have poor effect. Forty Children had various degrees of psychological abnormalities and motor regression. Among them 13 cases had psychological abnormalities and motor regression before disease; cognitive ability of 27 cases were normal before onset age, however, about 75% to 95% of the children became abnormal 2 years after atypical absence seizures. The rest 3 cases had no obviously impairment. Conclusions Most of the atypical absence seizures children had small onset age and high incidence in mental damage and cognitive impairment. The course of typical absence seizures aggravate gradually, and often develops to nonspecific brain damage in this process. Antiepileptic drugs can reduce the frequency of the seizure in part of the patients, but had no effect on psychological and motor regression.
ObjectiveTo investigate characteristics of motor semiology of epileptic seizure originated from dorsolateral frontal lobe. MethodsRetrospectively analysis the clinical profiles of patients who were diagnosed dorsolateral frontal lobe epilepsy (FLE) based on stereoelectroencephalography (SEEG) and underwent respective surgeries subsequently. Component of motor semiology in a seizure can be divided into elementary motor (EM, include tonic, versive, clonic, and myoclonic seizures) and complex motor (CM, include automotor, hypermotor, and so on). A Talairach coordinate system was constructed in the sagittal series of MRI images in each case. From the cross point of VAC and the Sylvian Fissure, a line was drawn antero-superiorly, which made an angle of 60° with the AC-PC line, then the frontal lobe could be divided into anterior and posterior portion. The epileptogenic zone, which was defined as ictal onset and early spreading zone in SEEG, was classified into three types, according to the positional relationship of the responding electrodes contacts and the "60° line": the anterior, posterior, and intermediate FLE. The correlation of the components of motor semiology in seizures and the location of the epileptogenic zone was analyzed. ResultsFive cases (26.3%) were verified as anterior FLE, among which there were 2 of EM, one of CM, and 2 of EM+CM. In 7 cases (36.8%) of intermediate FLE, there were one of EM, none of CM, and 6 of EM+CM. In the rest 7 cases of posterior FLE, there were 6 of EM, none of CM, and one of EM+CM. Compared with the cases that the epileptogenic zone involved anterior portion, the posterior FLE is more likely to present EM seizures (85.7%), and less likely to show CM components (P < 0.05). And Compared with the anterior FLE and posterior FLE, the intermediate FLE is more likely to present EM+CM seizures (85.7%)(P < 0.05). ConclusionThe motor seizure semiology of dorsolateral FLE has significant correlation with the localization of the epileptogenic zone. Posterior FLE mainly present a pure elementary motor seizure, and once the epileptogenic zone involved anteriorly beyond the "60° line", the component of complex motor seizure would be seen. Intermediate FLE, as its specialty of transboundary, is more likely to show "comprised semiology" of EM and CM. Construction of the "60° line" with AC-PC coordinate system in the MRI images may play an useful role in semiology analysis in presurgical evaluation of FLE.
Purpose To analyze the clinical characteristicsand prognostic factors of Status epilepticus (SE) in children. Methods The clinical data of 33 children with SE treated in Jinan Central Hospital Affiliated of Shandong University from January 2014 to June 2021 were collected, and their clinical characteristics were analyzed. Then, according to Glasgow prognosis scale, the children were divided into good prognosis group (n=20) and poor prognosis group (n=13). The age of first attack, duration of attack, type of attack and SE classification, EEG, cranial imaging and etiology were used to analyze the influencing factors of SE prognosis. Results 75.7% were 0 ~ 6 years old in the age of first attack, and 29 cases of convulsive status epilepticus accounted for 87.9% in the classification of seizure types. There were significant differences in age of first attack, duration of attack, EEG, history of mental retardation and etiology between the two groups (P<0.05); Logistic regression analysis showed that the age of first attack, duration of attack, history of mental retardation and EEG were independent factors affecting the prognosis. Conclusion Low age, especially ≤ 6 years old, is the high incidence of SE in children at first attack. Most children are symptomatic and have obvious incentives. Convulsive SE is the main type of SE in children. The age of first onset, duration of epilepsy, history of mental retardation, and EEG can affect the prognosis of SE.