摘要
【目的】通过经颅多普勒超声-视频脑电图(TCD-vEEG)同步监测技术多模态评价睡眠中癫痫电持续状态(ESES)的脑电图-脑血流动力学变化来探讨ESES引发患儿认知损害的神经电生理因素。【方法】纳入我院2017年8月至2019年3月的18名既往健康无结构性异常的ESES患儿,进行TCD-vEEG同步监测,并生成大脑中动脉平均血流速度(MCBFV)趋势曲线。由此测出非快速动眼睡眠期(NREM)期的棘波指数(SWI)及不同TCD参数。所有患儿根据临床发作情况、家长主诉的患儿认知表现、日常生活能力评分被分为3级;根据ESES前期的脑电图模式(pre-ESES)分为3型:①双侧同步对称癫痫灶(BSEF),②双侧不对称癫痫灶(BAEF),③多灶(MEF);据ESES模式分为2型:①绝对同步且广泛性(Near-ESES),②不对称ESES(Asym-ESES)。用SPSS17.0对所有数据根据分组进行Fisher精确检验,单因素方差分析或t检验。【结果】所有病例SWI为(85.22±5.22)%;与正常儿童比较,深睡期MCBFV波动为(17.98±7.98)%(t=7.579,P<0.01),深睡期MCBFV的均值(MCBFVm)为(92.81±21.53)cm/s(t=6.464,P<0.01),均显著增高。不同临床分级间的SWI(F=3.996,P<0.05)有显著差异。ESES模式与SWI无明显关系,但是Near-ESES模式对深睡期MCBFV波动影响较大(t=2.885,P=0.011)。【结论】ESES儿童存在明显的深睡期血流动力学变化,发作间期放电频率是ESES认知损害的重要因素,其中ESES模式与深睡期的CBFV波动密切相关。
【Objective】To evaluate the cerebral hemodynamic changes due to interictal epileptic discharges(IEDs)and explore the associated neuroelectrophysiological factors and cognition deficits on electrical status epilepticus during sleep(ESES)through real-time transcranial Doppler ultrasound-video-electroencephalogram(TCD-vEEG).【Methods】Eighteen ESES patients from August,2017 to March,2019 were recruited to undergo TCD-vEEG.The trend curve of mean cerebral blood flow velocity(MCBFV)was generated and analyzed.The spike wave index(SWI)and various TCD parameters during non-rapid eye movement(NREM)sleep were measured.The patients were divided into three clinical level groups based on seizures,their cognitive functions and the Activity of Daily Living Scale.According to the patterns of EEG during pre-ESES,the patients were also separately grouped to three groups:bilateral synchronous epileptogenic foci(BSEF),bilateral asynchronous epileptogenic foci(BAEF)and multiple epileptogenic foci(MEF).The patients were also separated into near-ESES and asymmetric ESES groups based on EEG patterns during ESES.We then per?formed Fisher′s precise test,an analysis of variance(ANOVA)and Student′s t-test,to determine that those parameters significantly varied according to clinical level and/or EEG pattern through SPSS 17.0.【Results】SWI was(85.22±10.33)%on average;MCBFV oscillations during deep sleep was(17.98±7.27)%on average(t=7.579,P<0.01);the mean of MCBFV(MCBFVm)was(92.81±21.53)cm/s on average(t=6.464,P<0.01);all increased significantly more than those of healthy children.SWI(F=3.996,P<0.05)revealed a statistically significant difference among three clinical level groups.ESES pattern had no obvious relation with the SWI,but Near-ESES influenced MCBFV oscillations during deep sleep significantly more(t=2.885,P=0.011).【Conclusions】There are obvious cerebral hemodynamic changes during NREM in ESES,and IEDs frequency are the important factors of cognitive impairment due to ESES.ESES pattern is closely related to MCBFV o
作者
彭炳蔚
李嘉铃
李小晶
朱海霞
梁薇
梁惠慈
PENG Bing-wei;LI Jia-ling;LI Xiao-jing;ZHU Hai-xia;LIANG Wei;LIANG Hui-ci(Department of Neurology,Guangzhou Women and Children′s Medical Center,Guangzhou 510120,China)
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2020年第3期485-492,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
中国抗癫痫协会科研基金(2017012)。
