脑电图(EEG)作为一种脑功能评估和脑疾病筛查的重要无创电生理检查手段,在空军飞行人员常规体检及神经系统疾病诊断中具有重要作用.合乎标准的仪器、规范的操作和正确的读图是确保EEG检查合理应用的前提条件.基于此,空军军医大学西京医院神经内科查阅国内外相关文献与指南,并结合我国、我军临床诊疗要求,就空军飞行人员EEG检查仪器要求、参数配置、电极安放、诱发试验及医技人员资质等制定了相关规范标准,为空军飞行人员标准化EEG检查提供参考和依据.

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.

癫痫发作作为脑卒中的首发症状或脑卒中后常见的并发症，其发生与发展可能会进一步影响脑卒中患者的预后。科学的处理脑卒中后癫痫发作对于脑卒中预后至关重要。关于卒中后癫痫发作和卒中后癫痫的大规模流行病学和高质量的临床研究依然有限，本文论述有关脑卒中后癫痫发作和脑卒中后癫痫的诊疗现状。

Breach rhythm was firstly described in 1979, and is considered as a rare benign variant of electroencephalogram. The etiology, electroencephalogram features and evaluation of breach rhythm, and so on, are discussed in this article.

目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)与不同睡眠分期的相关性.方法:选择经多项睡眠图(PSG)检查确诊的OSAS患者88例,根据NREM期和REM期的睡眠暂停通气指数(AHI)值,将患者分为REM相关OSAS组、NREM相关OSAS组、与睡眠分期无关OSAS组,比较3组患者整夜平均AHI(AHI总)、REM期AHI(AHIREM)、NREM期AHI(AHI-NREM)、最低SaO2、平均SaO2、最长呼吸暂停时间的差别;比较3组患者N1、N2、N3期睡眠占总睡眠百分比、REM占总睡眠百分比、睡眠效率的差别.结果:与睡眠分期无关OSAS组患者AHI-总、AHI-REM、AHI NREM、AHL仲卧位、AHL侧卧位最高,最长呼吸暂停持续时间最长,平均SaO2、最低SaO2最低,N1期睡眠所占总睡眠的百分比最高、N3期睡眠所占总睡眠的百分比最低,氧饱和度＜90％持续时间最长,差异均有统计学意义(P＜0.001).结论:3组患者中,与睡眠分期无关OSAS组的患者,其缺氧的程度及持续的时间、睡眠结构的紊乱程度最为严重.

Objective To investigate the electro-clinical features of epilepsy with eye closure sensitivity (ECS).Methods The electroencephalograph database was searched using ECS during half a year period from January to June 2017 in Xijing Hospital.The duration of the follow-up was one year.Results Fifty-one patients diagnosed as epilepsy with ECS were investigated.Patients were classified into four epilepsy syndromes:33 with eyelid myoclonia with absences (EMA);13 with juvenile myoclonia epilepsy (JME);two with epilepsy with generalized tonic-clonic seizure on awakening and three with idiopathic occipital lobe epilepsy (IOE).The duration of the epileptiform discharges (EDs) triggered by eye closure (ECL) lasted more than five seconds in four patients with EMA and one patient with IOE.The EDs triggered by ECL were more frequent (85.2± 11.4 vs 37.5± 12.6,t=12.399,P=0.000) and lasting longer ((4.3± 1.9) s vs (2.3±0.8) s,t=3.585,P=0.001) in EMA than in JME.Conclusions ECS is common in EMA.The frequency and duration of the EDs triggered by ECL are helpful for identifying EMA and JME.

目的 通过对伴有光敏感性的青少年肌阵挛癫痫(juvenile myoclonic epilepsy,JME)患者的临床及脑电生理进行分析,总结伴有光敏感性的JME的电临床特点.方法 将2015年9月～2017年5月在我院行长程视频脑电监测中确诊为伴有光敏感性的JME患者纳入此项研究.结果 42例伴有光敏感性的JME患者纳入此项研究,男∶女比例为0.4∶ 1;81％ (34/42)的伴有光敏感性的JME的发作形式为全面性强直-阵挛发作(GTCS)+肌阵挛发作(Mjs);所有患者在合眼状态均出现光敏性反应(PPR),且诱发频率多在8～25 Hz.多数光惊厥反应出现在合眼状态,最常见的发作形式为肌阵挛发作.结论 伴有光敏感性的JME患者中,女性具有显著发病优势,Mjs是伴有光敏感性的JME患者主要就诊原因,PPR和光惊厥反应最常出现于合眼状态.

目的:报道6例过度换气(HV)诱发试验阳性的局灶性癫痫患者,结合文献报道分析其临床和电生理特点.方法:对6例HV诱发试验阳性的局灶性癫痫患者进行临床和脑电生理随访研究.结果:6例HV诱发试验阳性患者,起病年龄为8～39岁;成人患者4例,儿童患者2例;男女比为4∶2;HV过程中发作类型为局灶演变为双侧强直-阵挛发作3例,局灶性知觉障碍、感觉性发作3例.结论:HV诱发试验阳性可见于局灶性癫痫的患者,尤其应注意额叶癫痫患者,应结合症状学及电生理特点,避免误诊或漏诊.

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.

Standardized electroencephalography (EEG) electrode positions are essential for both clinical applications and research.The aim of the International Federation of Clinical Neurophysiology (IFCN) guideline is to update and expand the unifying nomenclature and standardized positioning for EEG scalp electrodes.Twenty percent and ten percent standard recordings do not cover the anterior and basal temporal lobes.Here,IFCN proposes a basic array of 25 electrodes including the inferior temporal chain,which should be used for all standard clinical recordings.Contrary to the established belief,the guideline suggests at least as many electrodes in young children as in adults.High-density scalp EEG arrays (64-256 electrodes) allow source imaging with even sub-lobar precision.In the future,nomenclature for high density electrodes arrays beyond the 10-10 system needs to be defined,to allow comparison and standardized recordings across centers.

Exploding head syndrome(EHS)is a rare sensory parasomnia and rarely reported in China, leading to serious misdiagnosis, mistreatment, and unnecessary testing. A detailed collection of clinical symptoms and longterm polysomnography-electroencephalography monitoring is very important for diagnosis and differential diagnosis of EHS. We diagnosed a patient with EHS according to the International classification of sleep disorders, third edition diagnostic criteria. The electro-clinical feature of the patient and relevant references were analyzed in order to improve the understanding of EHS, meanwhile to prevent unnecessary testing and avoid misdiagnosis and mistreatment.

癫痫是一种慢性神经系统疾病,随着人们对癫痫认识的不断深入,非药物治疗癫痫的方法越来越多,然而口服抗癫痫药物仍然是治疗癫痫最常用的方法. 但是对于以下问题:何时开始抗癫痫药物治疗、如何确定抗癫痫药物的服用剂量以及减停抗癫痫药物的依据等问题,临床观点不一,有些临床实践尚需进一步商榷.

Objective To analyze the clinic features and radiologic characteristics of cryptogenic stroke patients with positive contrast-enhanced transcranial Doppler (c-TCD) examination. Methods Subjects diagnosed as cryptogenic stroke by TOAST subtypes were recruited consecutively from patients who were hospitalized in our hospital between January 2013 and December 2016. Subjects were divided into two groups: c-TCD positive group (with right to left shunt) and c-TCD negative group(without right to left shunt). Demographic characteristics, common risk factors of cerebrovascular disease, radiologic features of infarct focus were analyzed and compared. Results A total of 113 subjects were enrolled, including 60 ones in c-TCD positive group and 53 ones in c-TCD negative group. Using transesophageal echocardiography (TEE) and computed tomography (CT) pulmonary angiography, 52 in c-TCD positive group were diagnosed with patent foramen ovale (PFO), and 1 was diagnosed with atrial septal defect. Compared to the c-TCD positive group, the negative group was older (P<0.05), and had more risk factors including blood hypertension, high hypercholesteremia, and smoking (P<0.05). The difference of cases with no traditional risk factors between c-TCD positive and negative groups was significant (P<0.01). The two groups showed no significant difference in responsible vessels (P>0.05). Infarct foci in c-TCD positive group were more likely to be in cortical or subcortical area (P=0.004), while in negative group, they were more likely to be in deep grey matter (P=0.015). Conclusion Cryptogenic stroke patients with c-TCD positive tended to be younger, with less traditional risk factors (blood hypertension, high hypercholesteremia and smoking). There were no significant differences in responsible vessels between c-TCD positive and negative groups. Infarct foci in c-TCD positive group were more likely to be in cortical or subcortical area.

睡眠障碍是儿童神经科常见的问题,可单独发生或伴随其他神经疾病发生.睡眠障碍对儿童在认知、情绪、社会发展和行为表现等多方面造成损害.但是,一直以来,神经科医师对儿童睡眠障碍的认识相对较少,也缺乏睡眠评估和诊治的能力.失眠是儿科最常见的睡眠障碍,慢性睡眠障碍导致患儿白天出现精神行为异常及认知功能障碍,睡眠日记是诊断失眠的有力工具,行为咨询是儿童失眠管理的基础,认知行为治疗是治疗失眠的有效方法.异态睡眠和发作性睡病可能被误诊为癫痫发作等其他神经科疾病,导致不能得到及时有效的生活管理,出现不适当的药物暴露.文章着重介绍儿童失眠、异态睡眠和发作性睡病相应的临床表现、病理生理、诊断、治疗及研究现状,以期帮助神经科医生在诊治存在睡眠障碍的儿童过程中,准确诊断、提高对睡眠症状的评估及干预水平,优化疾病管理,改善患儿的睡眠状况,缓解家庭压力及照顾者的负担.

随着人们对癫?认识的进步，越来越多的抗癫?药物（A ED ）问世。目前国内大概有十余种 A ED可以用于治疗癫?。国际抗癫?联盟也在不断更新关于抗癫?药物使用的指南，无论哪一版指南，都在强调要根据癫?的发作类型选择抗癫?药物，但是没有提及 A ED 使用的剂量问题。随着各种新型A ED的问世，其药物有效剂量范围很大，如奥卡西平，其有效剂量大致在10～40 mg／kg ，如何为不同的癫?患者决定A ED的剂量是临床医生要面临的问题。剂量小，不能控制癫?发作；剂量大，不但增加患者的经济负担，还可能导致药物不良反应。现以3例病例为例阐述有关A ED使用剂量的一些体会，此3个病例均随访12个月以上。

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.