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目的探讨额叶癫痫临床症状和视频脑电图(VEEG)特征及其与睡眠的相关性。方法 2010年10月至2011年1月中国医科大学附属盛京医院小儿神经内科确诊的27例额叶癫痫患儿,对VEEG监测期间的55次发作进行分析,发作特点及脑电图特征分别由有经验的临床医师和脑电图医师进行双盲分析。结果 22例中6例(22.2%)仅于清醒时发作,11例(50.0%)仅于睡眠时发作,清醒、睡眠无有发作5例(27.8%)55次癫痫发作表现复杂,运动症状突出,主要形式表现为过度运动性自动症23次(41.8%),伴不同程度意识障碍及发声16次(29.1%),姿势性强直发作15次(27.3%),口咽自动症14次(25.5%),先兆10次(18.2%),局部阵挛发作8次(14.5%),偏转性强直6次(10.9%),临床下放电5次(9.1%),发作后朦胧4次(7.3%),额叶失神3次(5.5%)。发作间期脑电图能定位于额叶者19例(70.4%)。51次监测到临床发作,脑电图表现为发作时或发作前瞬间脑电图改变为额区起源的局灶性痫样波发放。结论额叶癫痫是一组临床表现复杂多样的癫痫综合征,发作间期及发作前瞬间脑电图改变具有重要的定位诊断意义,睡眠时VEEG尤为重要。
Objective To explore the clinical features of the frontal lobe epilepsy and video electroencephalogram (VEEG) features and its relationship with sleep. Methods From October 2010 to January 2011, 27 children with frontal lobe epilepsy diagnosed by Department of Pediatric Neurology, Shengjing Hospital of China Medical University analyzed 55 seizures during VEEG monitoring. The characteristics of attack and the characteristics of electroencephalography were analyzed by Experienced clinicians and electroencephalographers perform a double-blind analysis. Results Six of the 22 patients (22.2%) developed seizures only during wakefulness, while 11 (50.0%) seizures occurred only during sleep. There were no seizures in 5 days (27.8%) with seizures and no sleep. The 55 seizures showed complicated symptoms and prominent motor symptoms , Mainly manifested as hyperactivity disorder 23 times (41.8%), with varying degrees of disturbance of consciousness and vocalization 16 times (29.1%), gestational twitch 15 times (27.3%), oropharyngeal autism 14 times (10%), 10 (18.2%) precursors, 8 episodes of local clonus (14.5%), 6 cases of ankylosis (10.9%), 5 times of clinical discharges ), Frontal absence three times (5.5%). Interictal EEG was localized in the frontal lobe in 19 cases (70.4%). 51 times to detect clinical seizures, EEG showed seizures or before the onset of EEG changes to the frontal area of origin of focal epileptiform discharge. Conclusion Frontal lobe epilepsy is a group of complex and diverse clinical manifestations of epilepsy syndrome, seizure interval and the moment before the onset of EEG has important diagnostic significance positioning, VEEG sleep is particularly important.