颅内电极在感觉运动区皮质发育不良癫痫手术中的应用

目的:探讨长程颅内电极监测及电刺激方法,在感觉运动区皮质发育不良的难治性癫痫外科手术评估中的意义。方法:筛选MRI提示的皮质发育不良区域与重要功能区-感觉运动区位置关系密切的11例难治性癫痫患者,且头皮长程视频脑电监测及PET检查也初步提示癫痫发作与皮质发育不良所在脑区有关,在可疑脑区放置颅内电极,然后进行颅内电极长程视频脑电监测及电刺激检测,对癫痫起源位置及功能区定位,明确癫痫发作起源区域与感觉运动功能区的解剖学关系,在定位结果指导下进行切除术。结果:11例中3例位于左侧半球,8例位于右侧半球,11例感觉运动功能区皮质分布均存在不同程度变异,7例癫痫发作起源区域与感觉运动功能区一定范围重叠,其中5例与感觉区重叠,该5例切除了起源区域与发作有关的部分感觉区,2例部分致痫灶与运动区重叠,该2例仅切除了除与发作有关的运动区以外的癫痫起源区域,4例癫痫发作起源区域与感觉运动功能区相对独立,该4例完全切除癫痫发作起源区域;手术后6例患者发作消失,2例患者发作频率减少90%以上,1例癫痫发作控制无效,2例患者发生部分感觉缺失,但对生活无明显影响。结论:在皮质发育不良的癫痫患者中,有较高比例的病人伴有功能区皮层分布的变异,长程颅内电极监测及电刺激能够实现癫痫起源区域及功能区精确定位,明确功能区变异情况,对于指导病灶切除,避免损伤功能区皮质,减少术后并发症具有重要意义。     

脑肿瘤时致癫痫病变的免疫组织化学和电镜观察的研究

11例肿瘤致癫痫病患者在脑皮质电图和深部电极描记监测致癫痫灶下,行肿瘤和致痫灶的切除。用免疫组织化学方法检测肿瘤和致痫灶内的细胞浆内胶质原纤维酸性蛋白、神经细丝、纤维联结蛋白和内皮细胞及电镜观察。发现致痫灶分别在肿瘤灶(5例)和肿瘤的周边区(6例)内,每一致痫灶内见残留神经元或变性的轴索由瘤性或增生的星形细胞的胶质原纤维或增生血管周细胞的胶原原纤维围绕或包绕;致痫灶内神经元固缩或空泡变性,线粒体肿胀、粗面内浆网扩张,轴索变性及髓鞘板层分离。结合上述所见,讨论了星形细胞在癫痫发作中的机理。     

颅内电极在感觉运动区皮质发育不良癫痫手术中的应用

目的：探讨长程颅内电极监测及电刺激方法,在感觉运动区皮质发育不良的难治性癫痫外科手术评估中的意义。方法：筛选MRI提示的皮质发育不良区域与重要功能区-感觉运动区位置关系密切的11例难治性癫痫患者,且头皮长程视频脑电监测及PET检查也初步提示癫痫发作与皮质发育不良所在脑区有关,在可疑脑区放置颅内电极,然后进行颅内电极长程视频脑电监测及电刺激检测,对癫痫起源位置及功能区定位,明确癫痫发作起源区域与感觉运动功能区的解剖学关系,在定位结果指导下进行切除术。结果：11例中3例位于左侧半球,8例位于右侧半球,11例感觉运动功能区皮质分布均存在不同程度变异,7例癫痫发作起源区域与感觉运动功能区一定范围重叠,其中5例与感觉区重叠,该5例切除了起源区域与发作有关的部分感觉区,2例部分致痫灶与运动区重叠,该2例仅切除了除与发作有关的运动区以外的癫痫起源区域,4例癫痫发作起源区域与感觉运动功能区相对独立,该4例完全切除癫痫发作起源区域;手术后6例患者发作消失,2例患者发作频率减少90%以上,1例癫痫发作控制无效,2例患者发生部分感觉缺失,但对生活无明显影响。结论：在皮质发育不良的癫痫患者中,有较高比例的病人伴有功能区皮层分布的变异,长程颅内电极监测及电刺激能够实现癫痫起源区域及功能区精确定位,明确功能区变异情况,对于指导病灶切除,避免损伤功能区皮质,减少术后并发症具有重要意义。     

难治性癫痫致病灶术前定位EEG联合fMRI检查的临床研究

目的:探讨EEG联合f MRI检查在难治性癫痫致病灶术前定位中的准确性。方法:将我院在2013年9月~2014月9月收治的35例难治性癫痫患者作为研究对象,给予EEG联合f MRI检查对致病灶进行术前定位,分别对比EEG联合f MRI检查出的致病灶与手术中确定的致病灶的位置与范围,同时观察患者的致病灶手术切除效果。结果:有21例患者经EEG联合f MRI检查出的致病灶与手术中确定的致病灶位置与范围完全相同,有14例患者经EEG联合f MRI检查出的致病灶与手术中确定的致病灶位置相同,但检查出致病灶的范围明显大于术中确定致病灶的范围。患者在术后1年的随访中,有24例患者癫痫无复发,有6例患者在术后的1个月内癫痫发作1~4次,给予抗癫痫药物治疗后病情得到控制,有5例患者癫痫仍然再发作,且给予抗癫痫药物治疗后病情无法控制,但癫痫发作频率较术前低。结论:EEG联合f MRI检查在难治性癫痫致病灶术前定位中准确性高,且对患者无创,值得临床的推广及应用。     

长程颅内电极埋藏监测致痫灶治疗难治性癫痫的手术护理模式研究

目的:研究长程颅内电极埋藏监测致痫灶治疗难治性癫痫的手术护理模式 方法:回顾性总结120例颅内电极埋藏监测致痫灶治疗难治性癫痫的手术配合过程.结果:认为手术室护士全面了解手术过程,将患者存在的心理危机迅速识别出来,手术期间实施有效的心理护理和安全防护,熟练掌握手术步骤,熟悉各种精密仪器的作用原理和使用,是手术顺利进行的重要保证.结论:在癫痫患者控制发作及提高生活质量间找到最佳结合点,可使患者得到有效治疗和护理.     

左旋组氨酸对匹罗卡品致痫大鼠癫痫发作和海马区神经细胞凋亡的影响

目的:观察左旋组氨酸(L-His)对匹罗卡品(PLO)致痫大鼠皮质脑电图及大鼠海马各区神经细胞凋亡的影响。方法:雄性SD大鼠30只,随机平均分为对照组(匹罗卡品组)、干预组(匹罗卡品+左旋组氨酸组)。各组给予相关干预处理后腹腔注射匹罗卡品建立癫痫模型,行皮质脑电图观察及海马区细胞凋亡染色观察。结果:经皮质脑电图显示,干预组潜伏期延长、痫波频率及大发作次数较对照组明显降低,差异有统计学意义(P<0.05)。凋亡染色显示,对照组的海马各区细胞在各时间点的凋亡数明显高于干预组,差异具有统计学意义(P<0.05)。结论:左旋组氨酸可以延迟匹罗卡品致痫的形成并降低点燃后癫痫发作程度,降低海马各区细胞凋亡数值,提示左旋组氨酸具有抗痫作用。     

IL-1β、IL-lra对戊四氮致痫大鼠行为及皮层、海马脑电的影响

目的:了解白细胞介素1β(IL-1β)在癫痫发作中的作用.方法:采用记录脑电图(EEG)同时观察行为的方法,观察IL-1β和IL-1受体拮抗剂(IL-1ra) 侧脑室注射对戊四氮(PTZ)致痫大鼠行为和皮层、海马EEG的影响.结果:IL -1β能明显缩短 PTZ致大鼠急性惊厥发作及痫波发放的潜伏期,增加痫波的发放频率.IL -1ra能减少急性惊厥痫波发放频率,对急性惊厥发作及痫波发放的潜伏期和惊厥发作强度无明显影响.但IL-1ra能显著延长大鼠点燃后PTZ诱导的惊厥发作和痫波发放的潜伏期,减轻惊厥发作强度.结论:内源性IL-1β是促进癫痫发作的因素之一,可能在癫痫慢性发展中提高大脑神经元的兴奋性中起着重要作用.     

视频脑电图与常规脑电图在癫痫患儿诊断和定位中的应用价值对比研究

目的:比较视频脑电图(VEEG)与常规脑电图(REEG)在癫痫患儿诊断和定位中的应用价值,为癫痫诊断提供依据。方法:对2014年1月~2016年12月间本院收治的有临床症状拟诊断为癫痫的102例患儿的临床资料进行回顾性分析,比较VEEG与REEG两种方法痫样放电检出率、临床发作检出率、睡眠期检出率以及痫灶定位中的诊断价值。结果:102例患儿中,VEEG检测到痫样放电80例,痫样放电检出率为78.43%,REEG检测到痫样放电42例,痫样放电检出率为41.18%,VEEG痫样放电检出率显著高于REEG(P0.05)。VEEG临床发作检出率为48.75%,显著高于REEG临床发作检出率的14.29%(P0.05)。VEEG检测出睡眠期痫样放电检出率为46.25%,高于觉醒期痫样放电检出率的12.50%(P0.05)。VEEG睡眠期各电图时相痫样放电检出率比较,组间差异均有统计学意义(均P0.05)。根据VEEG确定39例癫痫患儿痫样放电起源部位为额区9例、颞区10例、额颞区9例、枕区4例、中央区4例、颞枕后区3例。结论:VEEG对癫痫患儿的脑部痫样放电检出率和临床发作检出率均明显优于REEG,同时定位诊断效果更优,值得临床推广应用。     

脑血管病所致癫痫发作的临床分析

目的 研究脑血管病后癫痫发作病人的临床分型及其与原发病和病灶的关系,评价脑电图、CT、MRI对癫痫的诊断价值以及治疗效果。方法 收集门诊病房几年来治疗的脑血管病合并癫癫发作的病人85例。按癫痫发作发生的时间和临床表现分型,每例病人均做CT、MRI和EEG。将数据进行统计学处理。结果 本组资料中,早期型癫痫26例（31％）,迟发型癫痫59例（69％）。癫痫发作类型以额叶癫痫最常见。脑梗死及多发病灶患者占比例大。药物治疗控制发作效果较好。脑电图能反映病情变化,病情控制后,服电图也逐渐好转。而CT、MRI地病灶的定位不能反映癫痫的类型。结论 多发病灶易致癫痫发作,额叶癫痫最常见。脑电图对癫痫的诊断和判断癫痫的控制很有帮助。CT、MRI无助于癫痫的诊断和评价。药物治疗效果较好。     

癫痫模型大鼠海马CA1网络theta节律断裂的观察*

目的:探究尖波间期和无尖波恢复期颞叶癫痫大鼠模型的海马CA1网络theta节律随癫痫发展进程的变化规律。方法:14只成年雄性Wistar大鼠(200～250 g)麻醉后开颅,在海马的背侧埋入一个双极性钢电极(直径小于1 mm),在颅骨上埋入三个不锈钢皮质电极,在左和右额皮质内分别植入两个电极,在小脑埋入参考电极,粘合颅骨,检测、记录大鼠脑电图;之后腹腔注射癫痫诱发药物,匹罗卡品氢氯化物(pilocarpine hydrochloride,310 mg/kg),30 min后给予大鼠莨菪碱 (scopolamine, 1 mg/kg);借助14只大鼠在嗅行(exploration)时脑深部记录(SEEG),应用Gabor小波时频能量分析估算断裂段数(以350 ms为1段),与总段数的比值定义为断裂比,用来衡量theta节律断裂程度,分别计算了癫痫发展进程的早期(D7)和晚期(D25)中两个邻近尖波之间时间段(定义为尖波间期)和随后无尖波恢复期theta节律断裂比,与注射前脑电图比较。结果:① 与对照脑电图比较,癫痫诱发大鼠的D7和D25的theta节律断裂比显著升高(P＜0.05),并且D7远高于晚期D25;② 在无尖波恢复期,theta节律断裂比与尖波间期相当 (P＜0.05)。结论:癫痫尖波直接导致了theta节律断裂,断裂程度将随癫痫发展进程而动态变化,早期伤害尤其严重。     

Parental generalized EEG alpha activity predisposes to spike wave discharges in offspring

Familial and twin studies have shown that the individual variability of the normal human electroencephalogram (EEG) is largely genetically determined. In epileptology, these genetic parameters of the EEG background activity are almost totally neglected. The aim of the present study has been to investigate whether a special genetic type of background activity might be related to the pathogenesis of epilepsy. EEG recordings of parents of 257 epileptic children were evaluated retrospectively. Some 156 healthy adults served as controls. Special attention was paid to alpha activity extending to the frontal region, both in bipolar and in referential recordings (Alpha I). Alpha I was found significantly more often in parents of children with primary generalized epilepsy (18%) compared with parents of children with focal epilepsy (8%) or controls (9%). In a second step, parental EEGs of children with different EEG patterns associated with epilepsy were studied. Alpha I was found significantly more often in parents of children with focal sharp waves and generalized spikes and waves (26%) than in parents of probands with focal sharp waves without additional generalized spikes and waves (8%) or in controls (9%). Parents of probands with theta rhythms and spikes and waves had alpha I significantly more often (18%) than parents of probands with theta rhythms without additional spikes and waves (8%) or controls (9%). The findings reveal a clear correlation between the type of EEG background activity in parents and the EEG characteristics in their children, thus pointing to common mechanisms.     

Decoding Individual Finger Movements from One Hand Using Human EEG Signals

Brain computer interface (BCI) is an assistive technology, which decodes neurophysiological signals generated by the human brain and translates them into control signals to control external devices, e.g., wheelchairs. One problem challenging noninvasive BCI technologies is the limited control dimensions from decoding movements of, mainly, large body parts, e.g., upper and lower limbs. It has been reported that complicated dexterous functions, i.e., finger movements, can be decoded in electrocorticography (ECoG) signals, while it remains unclear whether noninvasive electroencephalography (EEG) signals also have sufficient information to decode the same type of movements. Phenomena of broadband power increase and low-frequency-band power decrease were observed in EEG in the present study, when EEG power spectra were decomposed by a principal component analysis (PCA). These movement-related spectral structures and their changes caused by finger movements in EEG are consistent with observations in previous ECoG study, as well as the results from ECoG data in the present study. The average decoding accuracy of 77.11% over all subjects was obtained in classifying each pair of fingers from one hand using movement-related spectral changes as features to be decoded using a support vector machine (SVM) classifier. The average decoding accuracy in three epilepsy patients using ECoG data was 91.28% with the similarly obtained features and same classifier. Both decoding accuracies of EEG and ECoG are significantly higher than the empirical guessing level (51.26%) in all subjects (p<0.05). The present study suggests the similar movement-related spectral changes in EEG as in ECoG, and demonstrates the feasibility of discriminating finger movements from one hand using EEG. These findings are promising to facilitate the development of BCIs with rich control signals using noninvasive technologies.     

Functional microsurgical partial callosotomy in patients with secondary generalized epilepsies. II. Mesial surface electrocorticography

Eight patients with secondary generalized epilepsy not alleviated by medical treatment underwent partial callosotomy. During the surgical procedure, they had mesial surface ECoG recordings taken from both frontal and parietal lobes, using large flat multilead platinum electrodes, and simultaneously recordings from a number of scalp positions, using needle electrodes. In all cases studied, this approach demonstrated one or, more commonly, several focal areas of epileptiform activity discharging independently over the mesial aspects of one or both hemispheres. The findings were correlated with the pre- and postoperative EEG patterns, in the light of current concepts of generalized epilepsies.     

Early Postnatal EEG Features of Perinatal Arterial Ischaemic Stroke with Seizures

Background

Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.

Objective

To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures.

Design

Retrospective observational study.

Patients

Neonates >37 weeks born between 2003 and 2011 in two hospitals.

Method

Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.

Results

Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%).

Conclusions

Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.     

Sleep-Stage Correlates of Hippocampal Electroencephalogram in Primates

It has been demonstrated in the rodent hippocampus that rhythmic slow activity (theta) predominantly occurs during rapid eye movement (REM) sleep, while sharp waves and associated ripples occur mainly during non-REM sleep. However, evidence is lacking for correlates of sleep stages with electroencephalogram (EEG) in the hippocampus of monkeys. In the present study, we recorded hippocampal EEG from the dentate gyrus in monkeys overnight under conditions of polysomnographical monitoring. As result, the hippocampal EEG changed in a manner similar to that of the surface EEG: during wakefulness, the hippocampal EEG showed fast, desynchronized waves, which were partly replaced with slower waves of intermediate amplitudes during the shallow stages of non-REM sleep. During the deep stages of non-REM sleep, continuous, slower oscillations (0.5–8 Hz) with high amplitudes were predominant. During REM sleep, the hippocampal EEG again showed fast, desynchronized waves similar to those found during wakefulness. These results indicate that in the monkey, hippocampal rhythmic slow activity rarely occurs during REM sleep, which is in clear contrast to that of rodents. In addition, the increase in the slower oscillations of hippocampal EEG during non-REM sleep, which resembled that of the surface EEG, may at least partly reflect cortical inputs to the dentate gyrus during this behavioral state.     

Radiosurgical treatment of epilepsy

Focal irradiation of epileptic foci has been performed in a group of 6 epileptic patients, of whom 2 presented with epilepsy and 4 with epileptic psychoses. The epileptic focus was localized by means of conventional scalp EEG, electrocorticography and stereoelectroencephalography. Radiosurgery was performed by coupling a stereoguide to a 60Co unit using a 10-mm diameter collimator. An estimated dose of 10 Gy was administered. Results are presented and the mechanism of action of radiation discussed.     

多发性抽动症的脑电图观察

目的:进一步探究脑电图对多发性抽动症患儿的辅助诊断价值。方法:本文对45例多发性抽动症患儿进行脑电图描记录,选择理想信号段进行分析。结果发现24例异常,异常率为53.3%。其中中度异常6例,占25%,脑波表现为在高幅δ、θ波长程阵发的背景上偶发尖波;轻度异常18例,占75%,表现背景脑波频率变慢,出现高幅δ、θ波及活动,伴短程出现;正常21例,较同年龄组的脑电图调节差,波形杂乱。结论:脑电图反映脑功能活动,通过计算机分析方法可提供更多信息,并且脑电图操作方便,无痛无创,易于被儿童接受,在多发性抽动症早期临床诊断中具有较高的应用价值。     

EEG simulation: variation of spectral envelope, pulse synchrony and ≈40 Hz oscillation

 Macroscopic EEG travelling wave phenomena and cortical pulse synchronisation effects are related within a single simple simulation. Non-specific activation acts to control the transfer function of the simulated cortex, and thus determines the relative amplitude of macroscopic EEG waves generated by rhythmic inputs. When concurrent asynchronous excitatory inputs to separate, local, cortical sites are introduced, the simulation reproduces both gamma-band (40 Hz) electrocorticogram (ECoG) activity and synchronous oscillation of action potential pulse density at the separate sites. The gamma-band ECoG and pulse synchrony effects depend on different mechanisms: the former upon local excitatory/inhibitory interactions, and the latter on cortico-cortical interactions. The pattern of synchronous activity depends upon both structural and dynamic aspects of gain, and is sustained by linearised versions of the simulation’s state equations. Dynamic properties of the simulation, which are independent of scale, describe both microscopic and macroscopic phenomena, all in accord with physiological findings. Received: 25 June 1996 / Accepted in revised form: 29 November 1996