[1]魏钰,但炜,陶园,等.动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究[J].第三军医大学学报,2019,41(05):461-466.
 WEI Yu,DAN Wei,TAO Yuan,et al.Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy[J].J Third Mil Med Univ,2019,41(05):461-466.
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动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第05期
页码:
461-466
栏目:
临床医学
出版日期:
2019-03-15

文章信息/Info

Title:
Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy
作者:
重庆医科大学附属第一医院神经外科
Author(s):
WEI Yu DAN Wei TAO Yuan SUN Chao XIE Yanfeng SHI Quanhong ZHAN Yan SUN Xiaochuan
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
 
关键词:
颅脑手术动态脑电图癫痫
Keywords:
craniocerebral operations ambulatory electroencephalogram epilepsy
分类号:
R651.110.6; R741.044; R742.101
文献标志码:
A
摘要:
目的 回顾性分析神经外科开颅术后预防性抗癫痫药停药后癫痫发作与未发作患者的动态脑电图(ambulatory electroencephalogram,AEEG)特点,定性、定量分析AEEG不同波形与癫痫发作的关系,探讨AEEG对预防性抗癫痫药物减停的指导价值。方法 选取我院神经外科2010年至2017年颅脑疾病开颅术后预防性抗癫痫用药停药后癫痫发作的166例患者(发作组),同期按年龄、性别、病因、部位与发作组相近比例分层选取的方法选取166例未发作的患者(对照组),随访时间为1~8年,分析两组的脑电图资料。参照Hughes J R根据慢波、棘尖波量的差异制定的分类方法,分为R型(rare,少量型)、R-M型(raremoderate,少-中量型)、M型(moderate,中量型)、M-L型(moderatelarge,中-大量型)、L型(large,大量型);NS型(no sharp waves,无棘尖波)、RS型(rare sharp waves,少量)、MS型(moderate sharp waves,中量)和LS型(large sharp waves,大量)。根据慢波出现方式分为3型:S型(scattered,散在性)、F型(focal,局灶性)、P型(paroxysmal同步阵发或暴发性)。分别比较两组停药前的脑电波差异。发作组根据再次服药后癫痫发作能否被控制分为控制组和未控制组,比较两组棘尖波数量之间的差异。结果 ①发作组和对照组患者的脑电图类型构成比差异有统计学意义(P<0.01)。从慢波数量上分析,发作组中以M型为主,对照组以R型为主,发作组中M、M-L、L型患者共91例(91/166,54.8%)显著高于对照组(14.5%);从慢波出现形式分析,发作组中以P型为主,对照组以S型为主,发作组中P型患者共107例(107/166,64.4%)显著高于对照组(34.3%);从棘尖波数量差异分析,发作组以MS型为主,对照组以RS型为主,发作组中MS、LS型患者共116例(116/166,69.8%)显著高于对照组(22.9%)。M型、M-L型、L型及P型慢波,MS、LS型棘尖波为停药后癫痫发作的高危波形(OR>1)。②再次服药后,控制组中人数随棘尖波从RS型至LS型而逐渐减少,而未控制组人数逐渐增多。结论 M、M-L、L型慢波,P型慢波,MS、LS型棘尖波为神经外科开颅术后预防性应用抗癫痫药停药后癫痫发作的高危波形,AEEG对神经外科开颅手术患者预防性应用抗癫痫药物的减停有一定的指导价值。
 
Abstract:

Objective To retrospectively analyze the characteristics of ambulatory electroencephalogram (AEEG) in postcraniotomy patients, with epileptic seizures and without seizures after reduction of preventive antiepileptic drugs, and qualitatively and quantitatively investigate the relationship between AEEG waveforms and seizures, in order to explore the guiding value of AEEG for the reduction of prophylactic antiepileptic drugs. Methods A total of 166 postcraniotomy patients with epileptic seizures after discontinuation of prophylactic antiepileptic drugs admitted in our department from 2010 to 2017 were recruited and subjected to seizure group in this study. Another 166 postcraniotomy patients without seizure who have the similar proportions in age, gender, etiology, location with the seizure group in our department during the same period served as non-epileptic seizure group. The 2 groups of patients were followed up for 1 to 8 years. Referring to the classification of Hughes J R, we divided them into following types: R type (rare), R-M type (rare-moderate), M type (moderate), M-L type (moderate-large), L type (large), NS type (non-sharp spike), RS type (rare sharp spike), MS type (moderate sharp spike), and LS type (large sharp spike). The waves were also assigned into S type (scattered), F type (focal), and P type (paroxysmal) according to the appearance of slow waves. The differences of AEEG waveforms were compared between the 2 groups before the discontinuation of prophylactic antiepileptic drugs. The seizure group was further divided into a controlled subgroup and a noncontrolled subgroup according to whether the epilepsy be controlled after taking the drugs again. The number of spike-wave between the 2 subgroups was compared. Results ①Significant differences presented in AEEG type composition ratio between the patients in the seizure group and non-epilepsy seizure group (P<0.01). The main type was M-type in the seizure group, and R-type in the non-epilepsy seizure group. There were more patients (91/166, 54.8%) with M, M-L and L types in the seizure group, significantly higher than the other group (14.5%). For the slow waves, the main type was P-type in the seizure group and S-type in the control, and there were 107 patients (107/166, 64.4%) with P type in the former group, significantly higher than the other group (34.3%). For the number of spikewaves. The former group mostly had MS-type, while the control mainly had RS-type, and the patients with MS and LS-type (116/166, 69.8%) were larger than those in the control group (22.9%). The high-risk waveforms of seizures after discontinuation of prophylactic antiepileptic drugs were slow waves of M, M-L, L, P types and spike-waves of MS and LS types (OR>1). ②After taking the drugs again, the number of patients in the control group were gradually decreased from RS-type to LS-type, and the numbers in the uncontrolled group were gradually increased. Conclusion The high-risk waveforms for postcraniotomy seizures after discontinuation of anti-epileptic drugs are slow waves of M, M-L, L and P types and spike waves of MS and LS types. AEEG is of certain guiding value in the prevention and treatment of antiepileptic drugs in patients undergoing neurosurgical craniotomy.

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更新日期/Last Update: 2019-03-05