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目的探讨结节性硬化所致婴儿痉挛症患者的脑电图特征及术前定位。方法回顾性分析已接受手术治疗的31例结节硬化所致婴儿痉挛症脑电图背景构型,与年龄的相关性及痫灶定位情况。结果 1岁以内为典型高幅失律,1～3岁呈现多元化为典型失律、变异失律及正常背景活动,3岁以后以变异失律和正常背景为主导,合计占该年龄段的86%,少数演变成慢棘-慢约占10%,极少数残留为典型失律约占4%。定位局灶性放电(单灶)6例,一侧双灶7例,一侧多灶7例,双侧改变以一侧优势11例。本组随访3个月至6年,平均3.5年。31例患者中20例无发作,7例发作减少90%,3例减少75%,1例无改变。平均智商(IQ)从术前52.6分提高到61.8分。结论结节性硬化所致婴儿痉挛症脑电图背景构型可随年龄的增长由典型失律转归成变异失律和正常节律。EEG放电广泛,以双灶或多灶性改变为主,但可综合背景、发作间期及发作期定位找出痫灶放电优势侧,并结合临床表现、影像学特点等,找出致痫结节并予以手术切除,可获得良好的治疗效果。
Objective To investigate the EEG features and preoperative localization of infantile spasms caused by tuberous sclerosis. Methods A retrospective analysis of 31 cases of surgical treatment of nymphal cirrhosis of infantile spasms EEG background configuration, with age and location of the epileptogenic lesions. Results Within 1 year of age, typical high-amplitude maladjustment was found. The age from 1 to 3 years showed diversification as the typical law of maladjustment, the law of variation and the normal background activity. After 3 years of age, the maladjustment led by the law of variation and the normal background, 86%, a few evolved into slow spines - slow about 10%, a very small number of typical loss accounted for about 4%. Localized focal discharge (single) in 6 cases, one side double stove in 7 cases, one side multifocal in 7 cases, bilateral change to one side advantage in 11 cases. The group was followed up for 3 months to 6 years, an average of 3.5 years. Twenty patients had no seizures in 31 patients, 90% were reduced in 7 patients, 75% were reduced in 3 patients, and 1 patient had no change. The average IQ increased from 52.6 points preoperatively to 61.8 points. Conclusion The structural background of EEG in infantile spasms caused by tuberous sclerosis may turn into a law of variation and normal rhythm from the typical law of failure with the increase of age. EEG discharge widely, mainly to double or multifocal changes, but can be integrated background, seizure interval and the onset of epileptic focus to find the discharge side, combined with clinical manifestations, imaging features, find the epileptogenic junction Festival and be surgically removed, can obtain a good therapeutic effect.