Electrical status epilepticus is a special electroencephalogram phenomenon,which means that the spike and slow waves are almost continuously emitted during the wake-sleep phases.Related concepts are epileptic encephalopa-thy with electrical status epilepticus during slow wave sleep,electrical status epilepticus in sleep,and subclinical electro-graphic seizures.The above related concepts are widely used in clinical practice,but there is a lack of unified criteria.There are abuses and misuses of these concepts.Clarifying related concepts is of great significance for scientific research and clinical practice.

Objective:To investigate the clinical and electrophysiological characteristics of patients with sudden unexpected death of epilepsy (SUDEP).Methods:Using "epilepsy" as the keyword, the relevant cases entered from October 2011 to March 2012 were searched in the database of the Electroencephalogram (EEG) Monitoring Center, Xijing Hospital, the Air Force Military Medical University. Telephone follow-up was conducted for all confirmed epilepsy patients, and for the death cases confirmed by telephone follow-up, the patients identified as consistent with SUDEP diagnosis were included in this study based on their past medical history, clinical data, death details, etc, and their clinical and neuroelectrophysiological characteristics were summarized and analyzed.Results:Among the 1 232 patients who underwent 24-hour video-EEG monitoring during the study period, 354 patients were successfully followed up by telephone interview, of whom 17 patients were died (4.8%), 12 individuals met the diagnosis of SUDEP (7 men, 5 women). The duration of the disease in 9 patients exceeded 10 years. Eight cases presented with focal-bilateral tonic clonic seizures. Nine patients were treated with anti-seizure drug monotherapy. All the 24-hour video EEG of 12 patients were abnormal. There were 8 occasions when the EEG occipital α background rhythm slowed down compared with the standard frequency of peers or was dominated by slow waves. Interictal epileptic discharge (IED) located in temporal lobe were found in 12 EEG records, of which 9 EEG records were found with frontal IED. One of the 12 cases received 24-hour video EEG twice within 6 years, and his EEG background rhythm was significantly slower and the IED region was expanded compared with the first EEG record. At the third year after reexamination of EEG, SUDEP developed in this patient.Conclusions:SUDEP patients have a long course of disease and bilateral tonic-clonic seizure. The interictal EEG shows occipital slow α activity and temporofrontal epileptiform discharges, which may increase the risk of SUDEP.

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.

The cough related with lamotrigine in a patient with epilepsy was analyzed and summarized. According to the criteria of adverse drug reaction, the cough of the patient was the certain adverse reaction of lamotrigine. It is necessary to realize cough is an adverse reaction of lamotrigine, which is helpful to avoid the misdiagnosis and mistreatment of cough.

目的 探讨肌阵挛失神癫痫(epilepsy with myoclonic absences,EMA)的临床和电生理特点.方法 对我院脑电监测中心2018-2019年收治的3例EMA患者的临床和电生理特点进行总结和随访研究.结果 3例患者均为男性.2例儿童期起病,1例成年起病.1例表现为肌阵挛失神和全面性强直阵挛发作,2例表现为肌阵挛失神发作.3例发作期脑电图异常放电均不是标准的3Hz棘慢复合波,发作期棘慢复合波频率波动在2.5～3.5 Hz.2例间断闪光刺激诱发试验阳性,其中1例表现为光阵发性反应(1～60 Hz阳性),1例表现为光阵发性反应及光惊厥性反应.睁闭眼试验3例均为阴性.过度换气试验2例阳性,1例阴性.治疗给予丙戊酸钠缓释片,2例有效,1例仍有发作.结论 EMA多见于儿童,但也有较大年龄发病者.以肌阵挛失神为主要发作类型.EMA发作期脑电图可以是2.5～3.5 Hz棘慢复合波.EMA患者光敏性可为低频、高频均敏感.其肌阵挛失神发作容易被过度换气所诱发.治疗使用丙戊酸钠或丙戊酸钠联合拉莫三嗪,通常有效,存在认知功能损害,或伴随其他发作,特别是全面性强直阵挛发作的患者,可能预后不良.

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.

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 features, the video electroencephalography ( V-EEG) and synchronous electrocardiography ( ECG) changes in non-epileptic seizures and the significance of ECG monitoring in the diagnosis of epilepsy.Methods We collected 3 patients who came in a chief complaint of“episodes of unconsciousness with limbs twitch”, whose clinical features and EEG, ECG in longterm VEEG monitoring were analyzed.The 3 patients were followed up for at least 6 months.Results The 3 patients were all diagnosed as epilepsy in other hospital,and during the 24-hour VEEG monitoring in our hospital,2 patients showed abnormal cardiac rate and arrest during the attack and corresponding EEG changes after cerebral ischemia and hypoxia.After consultation with the department of cardiology, they were diagnosed as cardiac syncope episode and no attack showed up after the placement of pacemaker.The Q-T interval was prolonged in the other patient during the longterm ECG monitoring, after the coherence check who was diagonsed as severe hypocalcemia combined with myocardial damage due to a lower parathyroid function and had no attack after symptomatic treatment.Conclusions The synchronous ECG monitoring during the attack is of great significance in the differential diagnosis of epileptic and non-epileptic seizures. The ECG changes in patients with longterm VEEG monitoring should be focused on.It is necessary to add the early warning function to prevent the occurrence of accidents.