Objective:To explore the clinical and electro-physiological characteristics of reflex epilepsy induced by thinking activities.Methods:Five patients of reflex epilepsy induced by thinking activities during electroencephalogram (EEG) monitoring in the EEG Monitoring Center, Department of Neurology, Xijing Hospital,the Air Force Military Medical University from January 2017 to September 2019 were studied and followed up.Results:All the 5 patients are male, aged 14 to 33 years, with the disease course of 3 to 9 years and the follow-up of 1 to 4 years. The myoclonic jerks, spasms seizure and generalized tonic and clonic seizure occured to the 5 patients. The EEG background of low amplitude alpha rhythm was recorded in the 5 patiens. The ictal-EEG of 2 cases showed the spike wave or spike slow complex waves in the central, parietal area, and the ictal-EEG of 1 case showed the generalized spike-wave discharge. There were no seizures occuring to the 2 cases during video-electroencephalography monitoring. There were no abnormalities in cranial magnetic resonance imaging. The arterial spin labeling of 2 cases suggested that the right cerebral hemisphere cerebral blood flow was lower than contralateral. Antiseizure drugs (levetiracetam in 4 cases and levetiracetam+magnesium valproate in 1 case) were administered, 4 cases were seizure free and 1 case was uncontrolled.Conclusions:The reflex epilepsy induced by thinking activities is common in young men, and the EEG background with low amplitude alpha rhythm may be the characteristic of the reflex epilepsy induced by thinking activities. The levetiracetam may be the good choice for the reflex epilepsy induced by thinking activities and the prognosis of reflex epilepsy induced by thinking activities is good.

Objective:To investigate the clinical characteristics and electroencephalogram (EEG) of epilepsy patients with breach rhythm, improve clinical understanding of breach rhythm and avoid over-interpretation.Methods:Twelve epilepsy patients with breach rhythm who visited the Department of Neurology, Xijing Hospital, the Air Force Military Medical University from January 2016 to January 2017 were collected retrospectively. The clinical data, including etiology, clinical manifestations, EEG features and prognosis were summarized, and outpatient and telephone follow-up was performed for at least three years.Results:The clinical data of 12 patients with epilepsy with breach rhythm were collected, including eight males and four females, aged 36-78 years. After analysis, it was found that brain trauma was the most common cause of breach rhythm. Among them, two cases of skull defect were not repaired, eight cases were repaired with skull titanium mesh, one case was repaired with skull polymethylmethacrylate, and one case was repaired with skull polyetheretherketone. The distribution of the breach rhythm in 12 patients was consistent with the abnormal area of the skull. The breach rhythm can be expressed as high amplitude and fast frequency, or low amplitude and slow frequency and appear individually (similar to sharp waves, spikes). On the basis of pleomorphic slow waves, 10 patients were mixed with sharp waves and spike waves, and imaging confirmed that they had brain damage in corresponding parts. All of the 12 patients had a history of seizures, with tonic-clonic seizures and (or) focal seizures being the most common. Three patients with breach rhythm had no clinical seizures for more than five years, and had been taking antiepileptic drugs for epileptic spikes on EEG, and they were given reduction and discontinuation of the drugs and were seizure-free for three years during follow up.Conclusions:Skull repair is a common cause of breach rhythm, and repair materials with different resistances cause different waveforms and frequencies. Breach rhythm, epileptiform discharge and other pathological slow-wave activities can exist at the same time. Breach rhythm is a benign variant phenomenon which needs no special treatment.

目的 研究左乙拉西坦与拉莫二嗪治疗伴中央颞区棘波儿童良性癫痫(benign childhood epilepsy with centro-temporal spikes,BECT)的疗效.方法 选取空军军医大学西京医院神经内科脑电图监测中心2017 年1 月至2019 年12 月收治的符合纳入标准的60 例BECT 患儿,按随机数字表法分为对照组(31 例)和观察组(29 例).对照组给予拉莫三嗪治疗,观察组给予左乙拉西坦治疗,比较两组患儿的事件相关电位(ERP)P300 潜伏期、韦氏儿童智力量表(WISC-R)评分.结果 两组经治疗后ERP P300潜伏期均低于治疗前,WISC-R评分均高于治疗前,差异有统计学意义(P＜0.05);观察组和对照组患儿治疗前后ERP P300 潜伏期和WISC-R 评分差值比较,差异无统计学意义(P＞0.05).结论 左乙拉西坦与拉莫三嗪治疗均可降低BECT患儿ERP P300 潜伏期,改善其认知功能,临床可根据患儿情况选择合适的抗癫痫药物治疗.

家族性皮质肌阵挛震颤癫痫(FCMTE)是以皮质震颤、肌阵挛和双侧强直阵挛发作(BTCS)为主要表现的常染色体显性遗传性疾病,为探讨FCMTE的临床和电生理特点,作者对空军军医大学第一附属医院西京医院脑电监测中心收治的3例FCMTE患者的临床和电生理特点进行研究并随访.3例患者均为女性,表现为以上肢为主的震颤、肌阵挛,BTCS,癫痫性肌阵挛发作(包括眼睑肌阵挛发作),发作间期脑电图均为各导多棘波或(多)棘慢综合波,2例存在合眼敏感.给予抗癫痫药物(左乙拉西坦1例,丙戊酸钠1例,丙戊酸钠+氯硝西泮1例)治疗.随访1年以上,3例均无临床发作.说明需要关注FCMTE的癫痫性肌阵挛发作(包括眼睑肌阵挛发作)及合眼敏感,其在FCMTE中的意义尚需进一步研究.

Objective To investigate the electroclinical,treatment response and prognosis of juvenile absence epilepsy (JAE).Methods Thirty-two patients diagnosed as JAE from Epilepsy Center of Xijing Hospital between January 2014 and August 2017 were investigated.All of them underwent 24-hour video-electroencephalography (EEG) recording.Clinical aspects,electroencephalographic features,and antiepileptic drugs (AEPs) received were reviewed.The follow-up time was 6-44 months,with an average of (18.6 ± 11.6) months.Results Five patients (15.6％) had family history of epilepsy.Four patients (12.5％) had history of febrile seizures.Twenty-six patients (81.3％) showed absence seizures,11 patients (34.4％) were hyperventilation test positive,five patients (15.6％) were intermittent flash stimulation test positive.All the 32 patients received AEDs treatments,21 cases (65.5％) with monotherapy,nine patients (28.1％) with two AEDs,two patients (6.3％) with three AEDs.The most commonly used AED was valproic acid,and the second was levetiracetam.At the end of follow-up,five patients (15.6％) had complete seizure free and 27 patients (84.4％) had poor seizure control.Conclusions It is necessary to give electroclinical study on more samples of JAE and establish detailed practical diagnostic criteria about JAE as early as possible.More than half of JAE patients seizure control were not ideal.The monotherapy of JAE was less effective than combined treatment.

Objective To investigate the clinical and electrophysiological aspects of the transient epileptic amnesia.Methods We studied the clinical and electrophysiological characteristics of 6 patients diagnosed as TEA(transient epileptic amnesia).Results The age of 6 patients was ranging from 34 to 74 years old.The seizure types of them had amnesia,automatism,sGTCS,or a brief period of unconsciousness.The epileptiform discharge in the temporal region(unilateral or bilateral)was recorded in 5 patients.The other one patient' EEG was normal.5 patients were treated with antiepileptic drugs.3 patients were seizure free for a year,and 2 patients had epileptic seizures.Conclusion TEA is often misdiagnosis or missed diagnoses.Although the majority of temporal lobe epilepsy is reported as resistant to AEDs,our study suggested that temporal lobe epilepsy with TEA responded well to AEDs.

目的:探讨动态脑电图监测(AEEG)与同步录像结合分析的临床意义.方法:1 126例患者在配备有SONY-485P型可调式数字摄像镜头监测病房内进行24 h便携式脑电图监测.在EEG数据回放分析时,结合同步图像分析,观察患者的临床情况及周围环境,有效地识别各种干扰伪差及其来源,观察发作时的临床表现.结果:1 126例患者中EEG正常270例(23.98％),EEG异常856例,异常检出率为76.02％.其中确诊为癫(癎)者268例(78.13％),疑似癫(癎)者588例(75.09％),确诊癫(癎)组EEG异常率虽高于疑似癫(癎)组患者,但两组比较差异无统计学意义(P＞0.05).全组患者EEG有(癎)样放电者618例,占总异常的72.20％.确诊癫(癎)组有(癎)样放电者230例,占异常者的85.82％；疑似癫(癎) 组有388例,占异常者的65.99％,确诊癫(癎)组(癎)样放电阳性率明显高于疑似癫(癎)组,两组经统计学处理,差异有显著意义(P＜0.001).1 126例在行EEG监测的同时进行同步视频连续录像,拍摄到98例患者有临床发作,其中69例发作期EEG可见(癎)样放电；29例癫意患者临床发作时、发作间期均未见(癎)样放电.结论:AEEG结合视频录像,在尽可能不限制患者活动状态的前提下,通过视频录像记录观察患者的临床表现,与同步EEG对照分析,有效地提高了EEG(癎)样放电检出率.

目的分析玩麻将诱发癫患者发作间期脑电图(EEG)变化的特点及临床意义。方法回顾性分析2006年7月～2011年3月在本院癫中心行长程(8～24h)视频EEG监测的13例因玩麻将诱发癫患者发作间期的EEG改变。结果本组中有2例表现为全身强直-阵挛发作的患者发作间期EEG可见双侧大脑半球或双侧中央、额区多量单、连发棘波、尖、棘慢复合波、多棘波慢波发放,给予抗癫药物治疗,并嘱避免打麻将,未再发作。9例全身强直-阵挛发作和2例部分性发作继发全身性发作的患者发作间期EEG背景活动均出现不同程度的一种或多种异常改变,表现为α节律慢化、反应性及调节性消失、慢波性异常、快波性异常增多、清醒及浅睡眠中6或14Hz阳性棘波、中线θ节律。11例均未给予抗癫药物治疗,只嘱戒掉麻将并远离麻将环境。其中有1例发作间期EEG呈广泛间断性中-高幅5-7Hzθ节律,1例呈双侧额、中央、颞区阵发性高波幅3～5Hz慢波节律的患者在看家人打麻将、或通宵玩麻将中再次发作。结论玩麻将诱发的癫属于反射性癫,虽然戒掉麻将是避免发作的最佳方法,但对于EEG检查有明显癫样放电,或遵医行为不良,不能彻底摆脱打麻将或麻将环境的患者,则应按癫发作类型正规服用抗癫药物。同时由于玩麻将诱发癫发作的刺激因素非常复杂,声光等视觉刺激、思考、躯体感觉、本体感觉、焦虑、惊吓、激动、劳累等刺激因素影响常使大脑处于过度兴奋、乏氧状态,导致EEG背景活动不同程度的改变,在患者情况允许的前提下应定时行长程EEG监测。

目的 探讨眼睑肌阵挛失神癫痫的临床特点、脑电图特征、治疗以及预后.方法 对4例眼睑肌阵挛失神癫痫患者的临床症状、脑电图特点以及对抗癫痫药物治疗反应进行观察,并行文献回顾加以总结.结果 4例患者均为男性,表现为反复发生的眼睑肌阵挛及或眼球频繁向上滚动、伴短暂失神,脑电图伴频繁的高波幅的3～6 Hz棘慢波或多棘慢波发放,常由强光下合眼或闪光刺激诱发.发病至确诊时间为0 ～14年不等,其中3例因出现全面强直-阵挛发作(GTCS)就诊后行视频脑电监测时方确诊.病理波多位于前额、额、前颞、中线额导,枕导亦可见,但以额导显著.结论 眼睑肌阵挛失神癫痫由于复杂的症状学和抗癫痫药物的影响所致的脑电变化的遮蔽,常导致漏诊,规范的询问病史及常规行视频脑电检查对明确诊断具有极其重要价值.

目的 分析玩麻将诱发癫癎患者发作间期脑电图(EEG)变化的特点及临床意义.方法 回顾性分析2006年7月～2011年3月在本院癫痫 间中心行长程(8～24h)视频EEG监测的13例因玩麻将诱发癫癎患者发作间期的EEG改变.结果 本组中有2例表现为全身强直-阵挛发作的患者发作间期EEG可见双侧大脑半球或双侧中央、额区多量单、连发棘波、尖、棘慢复合波、多棘波慢波发放,给予抗癫痫 间药物治疗,并嘱避免打麻将,未再发作.9例全身强直-阵挛发作和2例部分性发作继发全身性发作的患者发作间期EEG背景活动均出现不同程度的一种或多种异常改变,表现为α节律慢化、反应性及调节性消失、慢波性异常、快波性异常增多、清醒及浅睡眠中6或14Hz阳性棘波、中线θ节律.11例均未给予抗癫痫 间药物治疗,只嘱戒掉麻将并远离麻将环境.其中有1例发作间期EEG呈广泛间断性中-高幅5-7Hzθ节律,1例呈双侧额、中央、颞区阵发性高波幅3～5Hz慢波节律的患者在看家人打麻将、或通宵玩麻将中再次发作.结论 玩麻将诱发的癫癎属于反射性癫癎,虽然戒掉麻将是避免发作的最佳方法,但对于EEG检查有明显癫痫 间样放电,或遵医行为不良,不能彻底摆脱打麻将或麻将环境的患者,则应按癫癎发作类型正规服用抗癫癎药物.同时由于玩麻将诱发癫痫 间发作的刺激因素非常复杂,声光等视觉刺激、思考、躯体感觉、本体感觉、焦虑、惊吓、激动、劳累等刺激因素影响常使大脑处于过度兴奋、乏氧状态,导致EEG背景活动不同程度的改变,在患者情况允许的前提下应定时行长程EEG监测.

目的:探讨Gastaut型特发性儿童枕叶癫的临床特征及预后情况.方法:对确诊为迟发型枕叶癫的15例患儿应用抗癫药物进行治疗,随诊并分析其临床特点、脑电图特征及预后情况.结果:发病平均年龄为9.1岁,男9例,女6例,临床特征为全部以全面性强直阵挛发作来就诊,追问病史后,常在全面性强直阵挛发作前1~2年有视幻觉、头眼偏斜及偏头痛等症状.简单视幻觉11例(73%),发作性视盲或视力模糊8例(53%),头痛7例(47%),眼球偏转10例(67%).发作间期脑电图示枕部导联为主的后头部棘波放电,单侧或双侧枕部导联出现,左右同步或不同步,常为闭眼诱发,睁眼抑制,伴同侧后颞导联棘波活动11例(73%),弥漫性棘波放电3例(20%).大部分单药治疗有效,部分需要联合用药.13例(87%)服药期间未再出现临床发作,2例服药后发作减少,但不能完全控制发作,其中有4例患儿服药后超过3年以上未再出现临床发作,并有停药后再次复发病史.结论:Gastaut型枕叶癫起病较晚,其临床表现较有特征,日间视觉症状突出,大多发作频繁,脑电图以枕导棘波放电为特点,抗癫药物控制效果较好,但停药后易复发,其归类为良性儿童癫综合征存在一定争议.