Garcia-Fernandez M
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
Rev Neurol. 2017 May 17;64(s03):S55-S59.
Epileptic spasms are the most frequent type of epileptic seizures in infants. They can also occur beyond the period of infancy, within the context of other epileptic encephalopathies or as an expression of a focal or generalised epilepsy. The clinical semiology of epileptic spasms varies greatly. They sometimes consist of very subtle clinical manifestations, which occur in series, without the typical axorhizomelic contraction, or in association with focal seizures. The critical EEG correlate is also very variable and basically consists of the combination of a hypervoltage slow wave, a bout of rapid low-amplitude activity or a diffuse attenuation of the trace. The electromyographic recording of both deltoids during the EEG-video study helps to detect clinically subtle spasms and to define certain features of them that are clinically hard to determine. The classic interictal EEG pattern of hypsarrhythmia, or one of its variants, is not always present. Epileptic spasms can sometimes be mistaken for another type of paroxysmal episodes that can be epileptic or non-epileptic, and the EEG-video study may play a key role for the differential diagnosis. Taken together, the findings from the EEG-video study allow an adequate diagnosis and classification of the different epileptic seizures and syndromes, which can optimise both the therapeutic management and aetiological investigation.
癫痫性痉挛是婴儿期最常见的癫痫发作类型。它们也可在婴儿期之后出现，见于其他癫痫性脑病，或作为局灶性或全身性癫痫的一种表现形式。癫痫性痉挛的临床症状学差异很大。它们有时表现为非常细微的临床表现，呈系列出现，无典型的轴性肌阵挛收缩，或与局灶性发作相关。关键的脑电图相关性也非常多变，基本由高电压慢波、一阵快速低幅度活动或脑电图描记的弥漫性衰减组合而成。在脑电图-视频研究期间对双侧三角肌进行肌电图记录，有助于检测临床上细微的痉挛，并确定其某些临床上难以确定的特征。典型的发作间期脑电图高度失律模式或其变体并不总是存在。癫痫性痉挛有时可能被误诊为另一种类型的发作性事件，可能是癫痫性的或非癫痫性的，脑电图-视频研究可能在鉴别诊断中起关键作用。综合来看，脑电图-视频研究的结果有助于对不同的癫痫发作和综合征进行充分的诊断和分类，从而优化治疗管理和病因学调查。
