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目的通过视频脑电图(VEEG)分析癫婴幼儿的发作类型。方法对深圳市儿童医院7 a来2岁以下且VEEG监测到发作性事件的1 000例患儿的临床资料进行回顾性分析。结果 1.全面性发作41例。其中强直-阵挛发作4例,持续时间为(59.75±58.93)s,中位数(M)38.50 s。强直相持续(17.25±15.81)s,M 12.50 s;阵挛相持续(35.00±29.54)s,M 29.00 s。发作期EEG主要表现为全导脑波抑制、全导棘波或低幅快活动发放后转变为棘波频率变慢夹杂慢波交替出现。强直发作6例,持续时间(36.66±16.97)s,M 34.00 s,发作期EEG为低中幅快节律持续发放。肌阵挛31例,持续时间(186.67±29.16)ms,M 200.00ms,发作期EEG为多尖棘慢波全导同发。2.痉挛发作302例。其中1岁内219例,1～2岁83例。发作持续时间为(1.35±0.67)s,M 1.00 s,发作间期背景EEG为高峰节律紊乱,其中210例为变异性高峰节律紊乱。临床表现屈肌型216例,伸肌型29例,混合型22例,眼球运动、轻微抖动等不典型发作35例。3.局限性发作232例。持续时间(107.34±104.88)s,M 70.00 s。临床表现为强直抖动(阵挛)样发作或无动性凝视(肢体无明显动作,肌张力无改变),多数意识状态难以准确判断,发作间期EEG为局限性癫样放电,EEG观察发作起源于额区13例、中央区20例、颞区46例和枕区13例,其余为多个部位起源,其中17例发作间期和起源部位不一致。4.癫持续状态10例。发作时临床表现为自动症或单侧肢体强直抖动为主,发作时间持续30 min以上或者反复发作,各次发作间意识未恢复至正常水平,EEG为局限性持续癫样放电。5.多种形式的发作43例,VEEG主要表现为一次发作中出现多种发作类型,痉挛伴局限性发作31例,痉挛伴肌阵挛发作11例,痉挛伴局限性发作、肌阵挛发作1例。6.非癫性发作372例。清醒期发作214例,睡眠期发作111例,清醒及睡眠期均有发作47例。突出表现为轻微抖动,非性强直等现象,EEG为动作伪差或与背景一致。结论婴儿期癫发作的主要类型是痉挛发作和局限性发作,非性发作也常见,临床对癫性发作与非癫性发作鉴别诊断很重要。VEEG监测同步分析有助于婴幼儿癫发作的准确观察与分类。
Objective To analyze the types of seizures in infants and young children by video EEG (VEEG). Methods A retrospective analysis was performed on the clinical data of 1 000 children under 7 years old who were under 2 years of age from Shenzhen Children’s Hospital and were monitored for VEEG. Results 1. Comprehensive attack in 41 cases. There were 4 cases of tonic-clonic seizures with a duration of (59.75 ± 58.93) s and a median (M) of 38.50 s. The duration of tonic phases was (17.25 ± 15.81) s, M 12.50 s; the clonus was continuous (35.00 ± 29.54) s, M 29.00 s. Seizure EEG mainly manifested as all-lead brain wave suppression, all-spike or low-amplitude rapid release of movement into a spike frequency slow mixed with slow waves alternately. 6 cases of tonic seizures, duration (36.66 ± 16.97) s, M 34.00 s, attack EEG for the middle and low amplitude fast-paced sustained release. Myoclonus in 31 cases, duration (186.67 ± 29.16) ms, M 200.00ms, episodes of EEG multi-spike slow-wave all-cause simultaneous. Spasm seizures in 302 cases. Of which 219 cases of 1-year-old, 1 to 2 years old in 83 cases. The duration of the episode was (1.35 ± 0.67) s, M 1.00 s. The background EEG in the interictal period was a peak rhythm disorder, of which 210 cases were the mutation rhythm disorder. Clinical manifestations of flexor type in 216 cases, 29 cases of extensor type, mixed type in 22 cases, eye movements, slight jitter and other atypical episodes in 35 cases. 3. Limitations 232 cases of onset. Duration (107.34 ± 104.88) s, M 70.00 s. Clinical manifestations of ankylosis (clonic) like or no active gaze (limb no obvious action, no change in muscle tone), most of the state of consciousness is difficult to accurately determine the interictal EEG for the limitations of epileptiform discharges, EEG observed seizures Originated in the frontal area in 13 cases, 20 cases of central area, 46 cases of temporal area and 13 cases of occipital region, the rest of the origin of multiple parts, of which 17 cases of intercourse and the origin of the site is inconsistent. 4. Epilepsy sustained state in 10 cases. The onset of clinical manifestations of autoimmune or unilateral limb stiffness dizziness, seizures lasting more than 30 min or recurrent episodes of consciousness between the seizures did not return to normal levels, EEG is limited persistent epileptic discharge. 5. Multiple forms of seizure in 43 cases, VEEG mainly manifested as a variety of seizures in a seizure type, spastic with 31 cases of focal seizures, spasm with myoclonic seizures in 11 cases, spasms with confined seizures, myoclonic seizures 1 case. 372 non-epileptic seizures. In the awake period, 214 cases were attacked, 111 cases were in the sleep stage, and 47 cases were sober and in the sleep stage. Prominent performance of a slight jitter, non-atrophy and other phenomena, EEG pseudo-action or in line with the background. Conclusion The main types of epileptic seizures in infancy are spastic seizures and localized seizures. Non-seizures are also common. Clinical diagnosis of epileptic seizures and non-epileptic seizures is very important. VEEG monitoring synchronization analysis can help the accurate observation and classification of infantile epilepsy.