1、发作期颅内电极脑电图表现形式发作期颅内电极脑电图表现形式王静，刘兴洲王静，刘兴洲2014.09颅内电极脑电图发作起始颅内电极脑电图发作起始 Seizure onset was defined as a sustained rhythmic change in the EEG accompanied by subsequent clinically typical seizure activity,at a frequency of 2 Hz,not explained by level of arousal,and clearly distinguished from background E
2、EG and interictal activity.癫痫发作起始脑电图：一种持续性脑电图改变，频率癫痫发作起始脑电图：一种持续性脑电图改变，频率2Hz，明显不同，明显不同于背景和间歇期脑电活动，排除不同水平的唤醒反应，伴有继之出现的于背景和间歇期脑电活动，排除不同水平的唤醒反应，伴有继之出现的典型临床发作。典型临床发作。Spencer S,Epilepsia,1992,33(3):537-45起源于颞叶的颅内电极发作起始表现形式起源于颞叶的颅内电极发作起始表现形式 低波幅快活动：低波幅快活动：low-voltage fast(LVF)because the EEG was initially
3、 desynchronized,consisting of high-frequency,low amplitude discharges over 10 Hz(478 seizures from 68 patients）Velasco A,Engel J,Plasticity,7:1-2,49-58,2000 过度同步化放电：过度同步化放电：hypersynchronous activit ywith low frequency,high-amplitude spikes having a frequency under 2 Hz,and lasting more than 5 sec，wh
4、ich encountered more frequently than the first pattern起源于颞叶的颅内电极发作起始表现形式起源于颞叶的颅内电极发作起始表现形式 直流电漂移：直流电漂移：Direct Current shifting.It was shown that 89%of low-voltage fast-type seizures contained an initial slow wave,whereas hypersynchronous-type seizures did not show an initial slow wave.RH1RH2RH3RH4起源
5、于颞叶的颅内电极发作起始表现形式起源于颞叶的颅内电极发作起始表现形式Sun xj,M,21yrs,Age of onset:14 yrs;Seizure type:dialepticautomotor.Postsurgical follow-up:3 years with Engels I(a);Intracranial EEG Onset:RH2 with 18Hz LVF with initial slow.iEEG Seizure-Onset Patterns in 53 patients（266-Sz）with temporal and extratemporal epilepsy-L
6、ee,Spencer(s),et al.Epilepsia,41(3):297-307,2000Low-voltage fast activity(same as temporal lobe seizure);Rhythmic spike or spike-wave activity;Rhythmic round sinusoidal waves;Semirhythmic slow waves;High-amplitude spike activity;Zhou QJ,F,24yrs,Age of onset:3yrs,Seizure type:R finger clonicR hand dy
7、stonicGTCS,iEEG:same as hypersynchronous pattern after surgery follow-up:2 years,Engels I(b).Hypersynchronous followed by fast activity(28Hz)iEEG Seizure-Onset Patterns in 53 patients（266-Sz）with temporal and extratemporal epilepsy-Lee,Spencer(s),et al.Epilepsia,41(3):297-307,2000Low-voltage fast ac
8、tivity(same as temporal lobe seizure);Rhythmic spike or spike-wave activity;Rhythmic round sinusoidal waves;Semirhythmic slow waves;High-amplitude spike activity;Zhou H,F,17yrs,Age of onset 5 yrs,seizure semiology:sensory auraL arm tonic-clonicL unilateral tonic-clonic;iEEG 4Hz theta range of rhythm
9、ic spike-wave:after surgery follow-up:3 years with Engel II.BFIG.4A.continuedSeizure free rate in Spensers:rhythmic alpha-theta spike(-wave)activity,and rhythmic high-amplitude beta spike activity,were associated with a seizure-free rate of only 6.3%(including only one of 16 seizure-free patients).i
10、EEG Seizure-Onset Patterns in 53 patients（266-Sz）with temporal and extratemporal epilepsy-Lee,Spencer(s),et al.Epilepsia,41(3):297-307,2000Low-voltage fast activity;Rhythmic spike or spike-wave activity;Rhythmic round sinusoidal waves;Semirhythmic slow waves;High-amplitude spike activity;Rhythmic ro
11、und sinusoidal waves,in the alpha-theta range.This pattern did not show any spike or sharp componet;Yan M,F,33yrs,age of onset 5yrs,seizure simiology:automotor(LOC)GTCS,after surgery follow-up:3 months with Engels I(b)spreadingThe same seizure with spreading to contralateral cortical areaThe same pa
12、tient,seizure onset showing 5.6Hz theta with round sinusoidal wave with at left temporal neocortical contacts.Schiller et al.suggested this pattern with theta-delta frequency,as a remote propagated seizure patternEpilepsia 1998:39:380-388iEEG Seizure-Onset Patterns in 53 patients（266-Sz）with tempora
13、l and extratemporal epilepsy-Lee,Spencer(s),et al.Epilepsia,41(3):297-307,2000Low-voltage fast activity;Rhythmic spike or spike-wave activity;Rhythmic round sinusoidal waves;Semirhythmic slow waves;Semirhythmic slow waves80%)with DC shiftDuration of DC shift should be at least 3s.Amplitude from peak
14、 to peak varied from 200uV to 1mV.sunxiangjieDC shiftLow voltage fast(80%)with DC shiftIctal DC shifts is mainly surface-negative in polarity,but it has not been necessarily.They can precede(1-3s in 15%)or coincided with the conventional ictal EEG onset(in 85%of LVF seizures);DC shiftLow voltage fas
15、t(80%)with DC shiftDC shifts are seen in a more restricted area showing convetional ictal EEG changes,which may reflect epileptogenecity.Their occurrence often coincided with the electro-decremental pattern and LVF activity.DC shiftDC shifting may occur with“fast activity de novo”during seizure evol
16、ution,which should be concerned about presurgically.DC shiftDC shiftDC shift can be seen in the seizures originated from mesial-and neo-cortical regions.DC shifting would not simultaneously present as an initial event in the hypersynchronous type of EEG seizure onset.DC shiftLVFHypersychron.Rhythmic
17、 spikeOther patternsTotalMesial temporal7 (6,85.7%)2（1,50%）09(6,66.7%)Neocortical temporal3 (3,100%)2(2,100%)2(1,50%;1 unknown)7(6,85.7%)Extratemporal16(11,86.7%)4(2,50%)1(1,100%)21(14,66.7%)Total26(20,76.9%)8(4,50%)3(2,66.7%)37(24,66.7%)EEG Onset Patterns according to anatomic location in 40 casesE
18、EG Onset Patterns and Outcomes(),术后随访结果为术后随访结果为 Engel I&II级的患者例数及所占比例级的患者例数及所占比例 A.Seizure onset with low voltage fast activity and DC shift and hypersynchronous pattern recorded in iEEG are good indication for epilepsy surgery;B.Otherwise,a sustained rhythmic change in the EEG accompanied by subsequent clinically typical seizure activity,clearly distinguished from background EEG and interictal activity,remain the major consideration for presurgical resection.发作期颅内电极脑电图表现形式发作期颅内电极脑电图表现形式-小结小结
