Betting Luiz Eduardo, Mory Susana Barreto, Lopes-Cendes Iscia, Li Li M, Guerreiro Marilisa M, Guerreiro Carlos A M, Cendes Fernando
Department of Neurology, University of Campinas. Unicamp, Campinas SP, Brazil.
Epilepsia. 2006 Mar;47(3):523-8. doi: 10.1111/j.1528-1167.2006.00462.x.
To investigate the EEG profile and its contribution for diagnosis and management in a group of patients with a clinical diagnosis of idiopathic generalized epilepsy (IGE) who were referred to a tertiary hospital.
We retrospectively studied clinical and EEG features of 180 consecutive patients with IGE. Eighty patients were diagnosed with juvenile myoclonic epilepsy (JME), 35 had absence epilepsy (AE), 13 had generalized tonic-clonic seizures on awakening (GTCS-A), 28 had generalized tonic-clonic seizures only (TCS), and 24 had adult-onset idiopathic generalized epilepsy (AIGE). The EEGs were classified in typical (synchronous generalized spike or polyspikes-and-wave discharges with normal background), atypical (with clear focalities or asymmetries), and normal.
The 493 EEG exams were analyzed. The first EEG was normal in 45% of the 180 patients, and only 33% had typical abnormalities. AE had a higher proportion of typical examinations and needed fewer sequential examinations to register a typical abnormality compared with the other groups. By contrast, the serial EEG profile of TCS and AIGE showed a higher proportion of normal and atypical EEG findings.
These findings support previous recommendations that IGE patients should be treated with appropriate therapy based on clinical history. Waiting for a typical abnormal EEG pattern can generate an unacceptable delay in the correct diagnosis and treatment of these patients. In patients with long-term epilepsy, the diagnosis may be difficult. Furthermore, serial EEGs can help to elucidate the syndromic diagnosis, especially in patients with TCS and AIGE.
调查一组临床诊断为特发性全身性癫痫（IGE）并转诊至三级医院的患者的脑电图特征及其对诊断和治疗的作用。
我们回顾性研究了180例连续的IGE患者的临床和脑电图特征。80例患者被诊断为青少年肌阵挛性癫痫（JME），35例有失神癫痫（AE），13例有觉醒时全身性强直阵挛发作（GTCS-A），28例仅有全身性强直阵挛发作（TCS），24例有成人起病的特发性全身性癫痫（AIGE）。脑电图被分类为典型（同步性全身性棘波或多棘慢波放电且背景正常）、非典型（有明确的局灶性或不对称性）和正常。
对493次脑电图检查进行了分析。180例患者中45%的首次脑电图正常，仅有33%有典型异常。与其他组相比，AE的典型检查比例更高，记录到典型异常所需的连续检查次数更少。相比之下，TCS和AIGE的系列脑电图特征显示正常和非典型脑电图结果的比例更高。
这些发现支持了先前的建议，即IGE患者应根据临床病史接受适当治疗。等待典型异常脑电图模式可能会导致这些患者的正确诊断和治疗出现不可接受的延迟。对于长期癫痫患者，诊断可能困难。此外，系列脑电图有助于阐明综合征诊断，尤其是在TCS和AIGE患者中。
