Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Kahramanmaras Necip Fazil City Hospital, 46080, Dulkadiroglu, Kahramanmaras, Turkey.
Neurol Sci. 2022 Jun;43(6):3857-3866. doi: 10.1007/s10072-021-05808-9. Epub 2022 Jan 16.
Generalized paroxysmal fast activity (GPFA) is a rare and underreported EEG pattern known to be related to epileptic encephalopathy. We aimed to investigate the electroclinical spectrum of GPFA along with other atypical EEG features in patients without epileptic encephalopathy in routine EEG practice.
Outpatient EEG records of Hacettepe University Hospital were retrospectively reviewed between 2010 and 2020. Patients ≥ 18 years old with GPFA without epileptic encephalopathy were included. Electroclinical features of GPFA were analyzed. Atypical EEG features, epileptiform K-complexes and sleep spindles, and generalized polyspike train (GPT) were also investigated in this cohort.
Most of the 19 included patients had refractory epilepsy (68%), while 16% were seizure-free. Generalized epilepsy (GE) was present in 58% of patients, and the rest had structural-focal epilepsy (26%), combined generalized and focal epilepsy (11%), or childhood occipital epilepsy (COE) (5%). Atypical EEG features with full atypical morphology were found in 91% of patients with GE. All patients with GPFA provoked by sleep had epileptiform K-complexes. The presence of GPT was not different between the GE and non-GE groups and was higher in patients with GPFA occurring only during sleep (p = 0.017). In two patients, GPFA frequency increased postictally. A transition from fixation-off sensitivity to GPFA occurred in a patient with COE.
In this study, GPFA had a wide diagnostic range from focal to generalized epilepsy. The association of GPFA with other electroclinical features was of importance mostly for sleep outcomes; this finding might lead to a better understanding of epileptogenesis.
广泛阵发性快活动（GPFA）是一种罕见且报道较少的脑电图模式，已知与癫痫性脑病有关。我们旨在研究常规脑电图实践中无癫痫性脑病患者的 GPFA 及其它非典型脑电图特征的临床电特征。
回顾性分析 2010 年至 2020 年在哈塞特佩大学医院进行的门诊脑电图记录。纳入无癫痫性脑病且存在 GPFA 的患者。分析 GPFA 的临床电特征。在该队列中还研究了非典型脑电图特征、癫痫性 K-复合波和睡眠纺锤波以及广泛多棘波（GPT）。
19 例纳入患者中，大部分为耐药性癫痫（68%），16%为无癫痫发作。全身性癫痫（GE）见于 58%的患者，其余为结构性局灶性癫痫（26%）、合并性全身性和局灶性癫痫（11%）或儿童枕叶癫痫（COE）（5%）。具有完全非典型形态的非典型脑电图特征见于 91%的 GE 患者。所有因睡眠而诱发 GPFA 的患者均有癫痫性 K-复合波。GE 组和非 GE 组的 GPT 存在率无差异，且仅在睡眠中出现 GPFA 的患者中 GPT 存在率更高（p=0.017）。两名患者的 GPFA 频率在发作后增加。一名 COE 患者出现从凝视敏感性到 GPFA 的转变。
在本研究中，GPFA 的诊断范围从局灶性到全身性癫痫不等。GPFA 与其它临床电特征的关联对睡眠结果很重要，这一发现可能有助于更好地理解癫痫发生。
