头皮脑电图波型对动脉瘤性蛛网膜下腔出血继发癫痫的预测价值
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摘要
目的分析动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)头皮脑电图(electro-encephalogram,EEG)的特点,比较EEG不同波形特征与a SAH继发癫痫的关系,探讨头皮脑电图波型对a SAH后癫痫发生的预测价值。方法回顾性分析我院神经外科2014年1月至2017年1月312例a SAH患者脑电图资料,出院后平均随访半年以上。按照有无癫痫发作分为:发作组和非发作组。按癫痫发生时间分为早期癫痫组和晚期癫痫组。将头皮脑电图波形分为:Ⅰ型(正常脑电图)、Ⅱ型(慢波类型)、Ⅲ型(爆发性慢波类型)、Ⅳ型(典型棘尖波类型)和Ⅴ型(电发作类型),分别比较各组的头皮脑电图波形特征。结果 (1)312例a SAH患者中有44例诊断为癫痫,其癫痫发生率为14.1%,其中早期癫痫24例(7.7%),晚期癫痫20例(6.4%)。(2)发作组和非发作组患者脑电图类型构成比差异存在统计学意义(P<0.01)。发作组中脑电图类型以Ⅲ型和Ⅳ型为主(84.1%),非发作组以Ⅱ型为主(79.5%)。发作组中,Ⅲ型、Ⅳ型和Ⅴ型的比例(95.5%)显著高于非发作组(19.0%)。(3)早期癫痫组和晚期癫痫组患者脑电图类型构成比差异存在统计学意义(P<0.01),早期癫痫组以Ⅲ型最多(70.8%),晚期癫痫组以Ⅳ型最多(80.0%)。结论头皮脑电图对动脉瘤性蛛网膜下腔出血继发癫痫有一定的预测价值,Ⅲ型、Ⅳ型和Ⅴ型为a SAH继发癫痫的高危波型;Ⅲ型、Ⅳ型可能分别与早、晚期癫痫有关。
Objective To analyze the characteristics of scalp encephalogram( EEG) in the patients of aneurysmal subarachnoid hemorrhage( a SAH),compare the relationship of different brain wave patterns with secondary epilepsy after a SAH,and assess the predictive value of EEG patterns for epilepsy. Methods A retrospective study was performed on the EEG data of 312 a SAH patients admitted in our department from January2014 to January 2017. All patients were followed up for over half a year. According to the presence of epileptic seizures,the patients were divided into seizures and non-epileptic seizure groups. The former group were also assigned into early epileptic group and late epileptic group based on the time of seizure. The EEG morphological patterns were divided into type Ⅰ( normal EEG),type Ⅱ( slow wave type),type Ⅲ( explosive slow wave type),type Ⅳ( typical spikes sharp wave type),and type Ⅴ( electrographic seizure). The EEG patterns were compared in different groups. Results(1) In the 312 a SAH patients,there were 44 patients with epilepsy,with an incidence rate of 14. 1%,including 24 cases( 7. 7%) of early epilepsy and 20 cases of advanced epilepsy( 6. 4%).(2) There were significant differences in the EEG patterns between the seizures group and the non-epileptic seizure group( P < 0. 01). The main EEG pattern was type Ⅲ and type Ⅳ in the seizures group( 84. 1%),and type Ⅱ in the non-epileptic seizure group( 79. 5%). The proportion of typesⅢ,Ⅳ and Ⅴ was significantly higher in the seizures group( 95. 5%) than the non-epileptic seizure group( 19. 0%).(3) There were significant differences in the EEG patterns between the early and late epilepsy groups( P < 0. 01). Type Ⅲ was the most frequent type in the early epilepsy group( 70. 8%),and type Ⅳwas in the late epilepsy group( 80. 0%). Conclusion Scalp electroencephalogram has a certain predictive value for secondary epilepsy after aneurysmal subarachnoid hemorrhage. Types Ⅲ,Ⅳ and Ⅴ are high-risk wave types for secondary epilepsy. Types Ⅲ and Ⅳ type may be associated with early and late epilepsy.
Objective To analyze the characteristics of scalp encephalogram( EEG) in the patients of aneurysmal subarachnoid hemorrhage( a SAH),compare the relationship of different brain wave patterns with secondary epilepsy after a SAH,and assess the predictive value of EEG patterns for epilepsy. Methods A retrospective study was performed on the EEG data of 312 a SAH patients admitted in our department from January2014 to January 2017. All patients were followed up for over half a year. According to the presence of epileptic seizures,the patients were divided into seizures and non-epileptic seizure groups. The former group were also assigned into early epileptic group and late epileptic group based on the time of seizure. The EEG morphological patterns were divided into type Ⅰ( normal EEG),type Ⅱ( slow wave type),type Ⅲ( explosive slow wave type),type Ⅳ( typical spikes sharp wave type),and type Ⅴ( electrographic seizure). The EEG patterns were compared in different groups. Results(1) In the 312 a SAH patients,there were 44 patients with epilepsy,with an incidence rate of 14. 1%,including 24 cases( 7. 7%) of early epilepsy and 20 cases of advanced epilepsy( 6. 4%).(2) There were significant differences in the EEG patterns between the seizures group and the non-epileptic seizure group( P < 0. 01). The main EEG pattern was type Ⅲ and type Ⅳ in the seizures group( 84. 1%),and type Ⅱ in the non-epileptic seizure group( 79. 5%). The proportion of typesⅢ,Ⅳ and Ⅴ was significantly higher in the seizures group( 95. 5%) than the non-epileptic seizure group( 19. 0%).(3) There were significant differences in the EEG patterns between the early and late epilepsy groups( P < 0. 01). Type Ⅲ was the most frequent type in the early epilepsy group( 70. 8%),and type Ⅳwas in the late epilepsy group( 80. 0%). Conclusion Scalp electroencephalogram has a certain predictive value for secondary epilepsy after aneurysmal subarachnoid hemorrhage. Types Ⅲ,Ⅳ and Ⅴ are high-risk wave types for secondary epilepsy. Types Ⅲ and Ⅳ type may be associated with early and late epilepsy.
引文
[1]DEWAN M C,MOCCO J.Current practice regarding seizure prophylaxis in aneurysmal subarachnoid hemorrhage across academic centers[J].J Neurointerv Surg,2015,7(2):146-149.DOI:10.1136/neurintsurg-2013-011075.
[2]HARROUD A,CREPEAU A Z.Epilepsy and mortality after aneurysmal subarachnoid hemorrhage[J].Neurology,2017,89(3):222-223.DOI:10.1212/WNL.0000000000004125.
[3]HUTTUNEN J,LINDGREN A,KURKI M I,et al.Epilepsyassociated long-term mortality after aneurysmal subarachnoid hemorrhage[J].Neurology,2017,89(3):263-268.DOI:10.1212/WNL.0000000000004113.
[4]CHOI K S,CHUN H J,YI H J,et al.Seizures and epilepsy following aneurysmal subarachnoid hemorrhage:incidence and risk factors[J].J Korean Neurosurg Soc,2009,46(2):93-98.DOI:10.3340/jkns.2009.46.2.93.
[5]BLECK T P,CHANG C W.Ten things we hate about subarachnoid hemorrhage(or,the taming of the aneurysm)[J].Crit Care Med,2006,34(2):571-574.DOI:10.1097/01.ccm.0000199078.13109.26.
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[8]TSOURES E,LEWERENZ J,PINKHARDT E,et al.Electroencephalographic findings in patients with circumscribed thalamic lesions[J].Epilepsy Res,2017,135:115-122.DOI:10.1016/j.eplepsyres.2017.06.009.
[9]HOH B L,NATHOO S,CHI Y Y,et al.Incidence of seizures or epilepsy after clipping or coiling of ruptured and unruptured cerebral aneurysms in the nationwide inpatient sample database:2002-2007[J].Neurosurgery,2011,69(3):644-650.DOI:10.1227/NEU.0b013e31821bc46d.
[10]GILMORE E,CHOI H A,HIRSCH L J,et al.Seizures and CNS hemorrhage:spontaneous intracerebral and aneurysmal subarachnoid hemorrhage[J].Neurologist,2010,16(3):165-175.DOI:10.1097/NRL.0b013e3181c7cd0b.
[11]EBERSOLE J S.Current practice of clinical electroencephalography[M].4th Ed.Philadelphia:Lippincott Williams&Wilkins,2003.
[12]MCCORMICK D A,CONTRERAS D.On the cellular and network bases of epileptic seizures[J].Annu Rev Physiol,2001,63:815-846.DOI:10.1146/annurev.physiol.63.1.815.
[13]BECKER A J.Review:Animal models of acquired epilepsy:insights into mechanisms of human epileptogenesis[J].Neuropathol Appl Neurobiol,2018,44(1):112-129.DOI:10.1111/nan.12451.
[14]DUDEK F E,STALEY K J.The time course and circuit mechanisms of acquired epileptogenesis[M]//Jasper’s Basic Mechanisms of the Epilepsies.4th Ed.Bethesda:National Center for Biotechnology Information(US),2012:405-415.DOI:10.1093/med/9780199746545.003.0031.
[15]STALEY K J,WHITE A,DUDEK F E.Interictal spikes:harbingers or causes of epilepsy[J].Neurosci Lett,2011,497(3):247-250.DOI:10.1016/j.neulet.2011.03.070.
[16]ANNEGERS J F,HAUSER W A,COAN S P,et al.A population-based study of seizures after traumatic brain injuries[J].N Engl J Med,1998,338(1):20-24.DOI:10.1056/NEJM199801013380104.
[17]STALEY K J,DUDEK F E.Interictal spikes and epileptogenesis[J].Epilepsy Curr,2006,6(6):199-202.DOI:10.1111/j.1535-7511.2006.00145.x.
[2]HARROUD A,CREPEAU A Z.Epilepsy and mortality after aneurysmal subarachnoid hemorrhage[J].Neurology,2017,89(3):222-223.DOI:10.1212/WNL.0000000000004125.
[3]HUTTUNEN J,LINDGREN A,KURKI M I,et al.Epilepsyassociated long-term mortality after aneurysmal subarachnoid hemorrhage[J].Neurology,2017,89(3):263-268.DOI:10.1212/WNL.0000000000004113.
[4]CHOI K S,CHUN H J,YI H J,et al.Seizures and epilepsy following aneurysmal subarachnoid hemorrhage:incidence and risk factors[J].J Korean Neurosurg Soc,2009,46(2):93-98.DOI:10.3340/jkns.2009.46.2.93.
[5]BLECK T P,CHANG C W.Ten things we hate about subarachnoid hemorrhage(or,the taming of the aneurysm)[J].Crit Care Med,2006,34(2):571-574.DOI:10.1097/01.ccm.0000199078.13109.26.
[6]NARAYANAN J T,LABAR D R,SCHAUL N.Latency to first spike in the EEG of epilepsy patients[J].Seizure,2008,17(1):34-41.DOI:10.1016/j.seizure.2007.06.003.
[7]RAPER D M,STARKE R M,KOMOTAR R J,et al.Seizures after aneurysmal subarachnoid hemorrhage:a systematic review of outcomes[J].World Neurosurg,2013,79(5/6):682-690.DOI:10.1016/j.wneu.2012.08.006.
[8]TSOURES E,LEWERENZ J,PINKHARDT E,et al.Electroencephalographic findings in patients with circumscribed thalamic lesions[J].Epilepsy Res,2017,135:115-122.DOI:10.1016/j.eplepsyres.2017.06.009.
[9]HOH B L,NATHOO S,CHI Y Y,et al.Incidence of seizures or epilepsy after clipping or coiling of ruptured and unruptured cerebral aneurysms in the nationwide inpatient sample database:2002-2007[J].Neurosurgery,2011,69(3):644-650.DOI:10.1227/NEU.0b013e31821bc46d.
[10]GILMORE E,CHOI H A,HIRSCH L J,et al.Seizures and CNS hemorrhage:spontaneous intracerebral and aneurysmal subarachnoid hemorrhage[J].Neurologist,2010,16(3):165-175.DOI:10.1097/NRL.0b013e3181c7cd0b.
[11]EBERSOLE J S.Current practice of clinical electroencephalography[M].4th Ed.Philadelphia:Lippincott Williams&Wilkins,2003.
[12]MCCORMICK D A,CONTRERAS D.On the cellular and network bases of epileptic seizures[J].Annu Rev Physiol,2001,63:815-846.DOI:10.1146/annurev.physiol.63.1.815.
[13]BECKER A J.Review:Animal models of acquired epilepsy:insights into mechanisms of human epileptogenesis[J].Neuropathol Appl Neurobiol,2018,44(1):112-129.DOI:10.1111/nan.12451.
[14]DUDEK F E,STALEY K J.The time course and circuit mechanisms of acquired epileptogenesis[M]//Jasper’s Basic Mechanisms of the Epilepsies.4th Ed.Bethesda:National Center for Biotechnology Information(US),2012:405-415.DOI:10.1093/med/9780199746545.003.0031.
[15]STALEY K J,WHITE A,DUDEK F E.Interictal spikes:harbingers or causes of epilepsy[J].Neurosci Lett,2011,497(3):247-250.DOI:10.1016/j.neulet.2011.03.070.
[16]ANNEGERS J F,HAUSER W A,COAN S P,et al.A population-based study of seizures after traumatic brain injuries[J].N Engl J Med,1998,338(1):20-24.DOI:10.1056/NEJM199801013380104.
[17]STALEY K J,DUDEK F E.Interictal spikes and epileptogenesis[J].Epilepsy Curr,2006,6(6):199-202.DOI:10.1111/j.1535-7511.2006.00145.x.