颞叶癫痫脑电图特点

1、颞叶癫痫的发作期脑电图特点颞叶癫痫的发作期脑电图特点SAFE CLUB 2016-1-8 王静王静发作期头皮发作期头皮脑电图表现形式脑电图表现形式1 1、节律范畴的放电活动；节律范畴的放电活动；2 2、突发性快活动：放电频率、突发性快活动：放电频率13Hz13Hz；3 3、抑制现象：放电活动的波幅、抑制现象：放电活动的波幅1010v v；4 4、可重复性癫痫式样放电：连续出现、可重复性癫痫式样放电：连续出现3 3个或个或3 3个以上的个以上的放电；放电；5 5、不规则放电：、不规则放电：波形波形不规则、复合频率的放电；不规则、复合频率的放电；6 6、伪迹干扰：癫痫式样的放电被伪迹干扰，难于判断

2、、伪迹干扰：癫痫式样的放电被伪迹干扰，难于判断起始时间、形态和分布。起始时间、形态和分布。N. Foldvary; G. Klem, REEGT; J. Hammel; W. Bingaman; I. Najm; and H. Lders. The localizing value of ictal EEG in focal epilepsy NEUROLOGY 2001;57:20222028颞叶起始的发作期头皮脑电图特点颞叶起始的发作期头皮脑电图特点、节律范畴的放电活动节律范畴的放电活动突发性快活动突发性快活动可重复性癫痫式样放电可重复性癫痫式样放电局灶性或广泛性电位低减或低平局灶性或广泛

3、性电位低减或低平颞叶起始的发作期头皮脑电图特点颞叶起始的发作期头皮脑电图特点u 颞叶内侧型癫痫发作起始放电颞叶内侧型癫痫发作起始放电： 最常见的表现形式为最常见的表现形式为或或节律范畴节律范畴(5(59Hz)9Hz)的放电活的放电活动（动（74-83%74-83%发作）；发作）； 发作起始无侧向性或弥漫性，可出现后续局灶显著性放发作起始无侧向性或弥漫性，可出现后续局灶显著性放电（电（82-92%82-92%发作），常表现为节律性棘波；后续局灶性放发作），常表现为节律性棘波；后续局灶性放电出现在发作起始后电出现在发作起始后30s30s之内，认为具有定侧之内，认为具有定侧/ /定位意义，定位意义，

4、一般与发作起始的平均间隔时间为一般与发作起始的平均间隔时间为12.612.613.3s13.3s。Ekaterina Pataraia, Stefanie 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, 1998u 颞叶起始的发作结束后放电特点：颞叶起始的发作结束后放电特点：Mohammed M.S. Jan T

5、he value of postictal electroencephalogram in temporal lobe seizures Annals of Saudi Medicine, Vol 19, No 6, 1999 发作结束后脑电图是指发作期节律性放电活动消失；发作结束后脑电图是指发作期节律性放电活动消失； 发作结束后脑电图异常通常表现为发作结束后脑电图异常通常表现为节律的活动（频率：节律的活动（频率：1-3Hz1-3Hz，波幅是发作前背景活动波幅的，波幅是发作前背景活动波幅的50%50%以上）；以上）； 颞叶起始的发作，发作结束后颞叶起始的发作，发作结束后活动出现的意义：单纯活动

6、出现的意义：单纯部分性发作（部分性发作（55%55%），复杂部分性发作（），复杂部分性发作（85%85%），继发全身），继发全身强直强直- -阵挛发作（阵挛发作（100%100%）；常位于发作期癫痫放电最明显的）；常位于发作期癫痫放电最明显的部位，提示癫痫发作起始同侧半球。部位，提示癫痫发作起始同侧半球。 发作期颅内电极脑电图特点发作期颅内电极脑电图特点P. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset patterns: effect of underlying pat

7、hology Brain 2014:137;183-1961.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, low- to medium-voltage sharply-co

8、ntoured 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 et al., 2002)5.Burst of high-amplit

9、ude 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 attenuation7. Delta brush, rhythmic delta waves at 1-2Hz, with superimposed brief burst

10、s 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 pathology Brain 2014:137;183-196 Each p

11、attern 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 Delta brush exclusive to focal cortical

12、dysplasiaSeizure-onset patternsP. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset patterns: effect of underlying pathology Brain 2014:137;183-196Seizure-onset patterns in regions of seizure spread Sharp activity at =13Hz Low-voltage fast activity (all epileptogen

13、ic 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) - -慎用发作起始的波形特点判断致痫区慎用发作起始的波形特点判断致痫区P. Perucca, F. Dubeau and J. Gotman. Intracranial electroencephalographic seizure-onset patterns: effect of underlying pathology Brain 2014:137;183-196High-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