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癫痫持续状态的脑电图检查:术语、方案与解读

[Electroencephalography in status epilepticus: Glossary, protocol and interpretation].

作者信息

Gelisse P, Thomas P, Engrand N, Navarro V, Crespel A

机构信息

Unité médicochirurgicale de l'épilepsie, hôpital Gui-de-Chauliac, 80, avenue Fliche, 34295 Montpellier cedex 05, France.

出版信息

Rev Neurol (Paris). 2009 Apr;165(4):398-403. doi: 10.1016/j.neurol.2009.01.032. Epub 2009 Mar 10.

Abstract

Electroencephalography is a useful tool in the diagnosis and management of status epilepticus (SE) and it can also give prognostic information. It can help to confirm that an episode of SE has ended. It can identify the patients who have unsuspected subclinical seizures. There is a wide range of presentations of SE. Nearly all types of seizures have the potential of occurring in a repeated or continuous form. The polymorphic EEG patterns in SE reflect this wide variety. But controversial patterns also exist in the form of periodic epileptiform discharges. While some authors considered these patterns to be interictal or postictal, others postulate that these patterns are ictal. In these cases, clinical features are very important in order to conclude. Generalized convulsive SE is a medical emergency and the EEG is not necessary to make a diagnosis. Convulsive generalized SE requires immediate treatment and in this case, EEG is used in guiding treatment especially in refractory SE that may evolve into subtle SE. In non-convulsive SE, diagnosis is not obvious on the basis of clinical signs and symptoms alone and the diagnosis must be confirmed by urgent EEG. EEG can also be used to distinguish SE from psychogenic seizures, movement disorders and in patients who have causes of persistent loss of consciousness (metabolic encephalopathy, postanoxic encephalopathy). This article proposes a protocol for the use of the EEG in SE, guidelines and simple vocabulary for a good interpretation and comprehension of the EEG.

摘要

脑电图是诊断和管理癫痫持续状态(SE)的一种有用工具,它还能提供预后信息。它有助于确认SE发作已结束。它能识别出有未被怀疑的亚临床发作的患者。SE有多种表现形式。几乎所有类型的癫痫发作都有可能以重复或连续的形式出现。SE中的多形性脑电图模式反映了这种多样性。但也存在有争议的模式,即周期性癫痫样放电。一些作者认为这些模式是发作间期或发作后期的,而另一些人则推测这些模式是发作期的。在这些情况下,为了得出结论,临床特征非常重要。全身性惊厥性SE是一种医疗急症,诊断时不一定需要脑电图。惊厥性全身性SE需要立即治疗,在这种情况下,脑电图用于指导治疗,尤其是在可能演变为轻微SE的难治性SE中。在非惊厥性SE中,仅根据临床体征和症状诊断并不明显,必须通过紧急脑电图来确诊。脑电图还可用于将SE与心因性发作、运动障碍以及有持续性意识丧失原因(代谢性脑病、缺氧后脑病)的患者相鉴别。本文提出了在SE中使用脑电图的方案、指南以及便于对脑电图进行良好解读和理解的简单词汇。

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