Benbadis Selim R, Lin Kaiwen
Comprehensive Epilepsy Program, Department of Neurology, University of South Florida and Tampa General Hospital, Tampa, FL, USA.
Eur Neurol. 2008;59(5):267-71. doi: 10.1159/000115641. Epub 2008 Feb 8.
BACKGROUND/AIMS: The overinterpretation of EEGs is common and is an important contributor to the misdiagnosis of epilepsy. We reviewed our experience in order to clarify which EEG patterns are commonly overread as epileptiform.
We identified patients who were seen at our epilepsy clinic and were ultimately diagnosed as having conditions other than epilepsy. We selected those who had previously had an EEG read as showing epileptiform discharges and whose EEG was available for our own re-review.
37 patients met the above criteria. Eventual diagnoses were psychogenic nonepileptic seizures (10), syncope (7), other miscellaneous diagnoses (5) and unexplained nonspecific symptoms (15). None of the EEGs had epileptiform discharges. The descriptions of the abnormalities included 'temporal sharp waves' in 30, 'frontal sharp waves' in 2 and 'generalized spike-wave complexes' in 2. Three had no reports available to identify the alleged abnormality. The benign patterns mistaken for temporal (30) and frontal (2) sharp waves were simple fluctuations of background activity with temporal phase reversals.
By far the most common patterns overread as epileptiform are nonspecific fluctuations of background in the temporal regions, which are misread as temporal sharp waves.
背景/目的：脑电图过度解读很常见，是癫痫误诊的一个重要因素。我们回顾了我们的经验，以明确哪些脑电图模式常被过度解读为癫痫样放电。
我们确定了在我们癫痫门诊就诊且最终被诊断为非癫痫疾病的患者。我们选择了那些之前脑电图被解读为显示癫痫样放电且其脑电图可供我们重新审查的患者。
37名患者符合上述标准。最终诊断为精神性非癫痫发作（10例）、晕厥（7例）、其他杂项诊断（5例）和不明原因的非特异性症状（15例）。所有脑电图均无癫痫样放电。异常描述包括30例“颞叶尖波”、2例“额叶尖波”和2例“广泛性棘慢复合波”。3例没有可用于识别所谓异常的报告。被误认为颞叶（30例）和额叶（2例）尖波的良性模式是背景活动的简单波动伴颞叶相位反转。
迄今为止，最常被过度解读为癫痫样放电的模式是颞叶区域背景的非特异性波动，被误读为颞叶尖波。
