Honda Ryoko, Saito Yoshiaki, Okumura Akihisa, Abe Shinpei, Saito Takashi, Nakagawa Eiji, Sugai Kenji, Sasaki Masayuki
Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki.
Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Department of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago.
Epileptic Disord. 2015 Dec;17(4):425-35. doi: 10.1684/epd.2015.0783.
We characterized the clinico-neurophysiological features of epileptic spasms, particularly focusing on high-voltage slow waves during ictal EEG. We studied 22 patients with epileptic spasms recorded during digital video-scalp EEG, including five individuals who still had persistent spasms after callosotomy. We analysed the duration, amplitude, latency to onset of electromyographic bursts, and distribution of the highest positive and negative peaks of slow waves in 352 spasms. High-voltage positive slow waves preceded the identifiable muscle contractions of spasms. The mean duration of these positive waves was 569±228 m, and the mean latency to electromyographic onset was 182±127 m. These parameters varied markedly even within a patient. The highest peak of the positive component was distributed in variable regions, which was not consistent with the location of lesions on MRI. The peak of the negative component following the positivity was distributed in the neighbouring or opposite areas of the positive peak distribution. No changes were evident in the pre- or post-surgical distributions of the positive peak, or in the interhemispheric delay between both hemispheres, in individuals with callosotomy. Our data imply that ictal positive slow waves are the most common EEG changes during spasms associated with a massive motor component. Plausible explanations for these widespread positive slow waves include the notion that EEG changes possibly reflect involvement of both cortical and subcortical structures.
我们对癫痫性痉挛的临床神经生理学特征进行了描述，尤其关注发作期脑电图中的高电压慢波。我们研究了22例在数字视频头皮脑电图记录期间出现癫痫性痉挛的患者，其中包括5例在胼胝体切开术后仍有持续性痉挛的个体。我们分析了352次痉挛中肌电图爆发的持续时间、幅度、起始潜伏期，以及慢波最高正负峰的分布情况。高电压正性慢波先于可识别的痉挛性肌肉收缩出现。这些正性波的平均持续时间为569±228毫秒，肌电图起始的平均潜伏期为182±127毫秒。即使在同一患者体内，这些参数也有显著变化。正性成分的最高峰分布在不同区域，这与MRI上的病变位置不一致。正性之后的负性成分的峰值分布在正性峰值分布的相邻或相对区域。对于接受胼胝体切开术的个体，正性峰值的术前或术后分布，或两半球之间的半球间延迟均无明显变化。我们的数据表明，发作期正性慢波是与大量运动成分相关的痉挛期间最常见的脑电图变化。对这些广泛分布的正性慢波的合理解释包括，脑电图变化可能反映了皮质和皮质下结构均受累的观点。
