Search

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.

Brain network theory, the significance and practice in clinical epileptology

Currently, about one-third of patients with anti-epilepsy drug or resective surgery continue to have sezure, the mechanism remin unknown. Up to date, the main target for presurgical evaluation is to determene the EZ and SOZ. Since the early nineties of the last century network theory was introduct into neurology, provide new insights into understanding the onset, propagation and termination. Focal seizure can impact the function of whole brain, but the abnormal pattern is differet to generalized seizure. Brain network is a conception of mathematics. According to the epilepsy, network node and hub are related to the treatment. Graphy theory and connectivity are main algorithms. Understanding the mechanism of epilepsy deeply, since study the theory of epilepsy network, can improve the planning of surgery, resection epileptogenesis zone, seizure onset zone and abnormal node of hub simultaneously, increase the effect of resectiv surgery and predict the surgery outcome. Eventually, develop new drugs for correct the abnormal network and increase the effect. Nowadays, there are many algorithms for the brain network. Cooperative study by the clinicans and biophysicists instituted standard and extensively applied algorithms is the precondition of widely used clinically.

顶叶内侧—解剖、生理与癫痫

顶叶内侧主要包括楔前叶、后扣带皮质及压后皮质，为默认网络的关键部位，其功能尚未完全了解，与空间认知，记忆及图形方向的认知有关，并参与意识过程。顶叶内侧癫痫极为少见，又因起源于顶叶内侧面，因此对其特征，诊断标准的研究不多。主要分为两大类型：① 楔前叶癫痫，楔前叶与其他皮质区及皮质下结构有广泛的联系，可分为三部分：前感觉运动亚区、中认知亚区、后感觉亚区。发作症状包括前庭症状、视觉症状，还有运动症状；② 后扣带回癫痫，发作时有四种症状：过度运动、不对称性强直性姿势、自动症及呆滞发作。上述症状多数为发作发放扩布至其他脑区后出现的。头皮脑电图无定位价值，仅有颅内电极尤其是立体定向脑电图才能确定致痫区。绝大部分为药物难以控制发作者，一旦确诊外科治疗为最佳选择。

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。

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

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。

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。

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。

眶额区癫痫--有待深入研究的癫痫类型

眶额区位于双侧额叶下方前颅凹中, 嗅束将直回与其他脑回分开。眶额区本身在各脑回间, 以及与额叶凸面及内侧面, 颞叶有广泛的联系。眶额区起源的癫痫少见。发作开始均先出现动作停止、无反应及茫然, 而后根据扩布的不同出现:嗅觉异常、过度运动、头眼偏向同侧或对侧、重复动作等运动症状、自主神经症状, 还可以有难以确定的感觉异常、发笑、似曾相识、视幻觉、自动症。根据临床症状可以分为额叶型、颞叶型及额颞叶型。头皮脑电图很难提供有定位价值的异常, 常为额颞叶甚至双侧额颞叶异常。深部电极尤其是立体脑电图有定侧定位价值。眶额区癫痫几乎均为药物难治性癫痫, 应以外科治疗为主。