Zheng Li-Li, Chen Jing-Zhen, Zhuang Xiao-Rong, Miao Jia-Yin
Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China.
Front Neurol. 2022 May 27;13:879643. doi: 10.3389/fneur.2022.879643. eCollection 2022.
Neurosyphilis (NS) lacks specificity in clinical and imaging features, and patients are frequently misdiagnosed as viral encephalitis when they present with seizures. This study aimed to compare electroencephalography (EEG) in patients with seizures resulting from the two diseases and provide guidance for differential diagnosis.
A retrospective study on patients diagnosed with neurosyphilis and viral encephalitis with seizures in the Department of Neurology, Zhongshan Hospital, Xiamen University from 2012 to 2020.
A total of 39 patients with seizures caused by neurosyphilis and 40 patients with seizures caused by viral encephalitis were included. Chi-square test analysis showed that compared with patients with viral encephalitis, patients with neurosyphilis mainly developed in middle-aged and elderly people ( < 0.001), were more likely to have temporal epileptiform discharges ( < 0.001), and less likely to have status epilepticus (SE) ( = 0.029). There was difference between two groups in the EEG performance of lateralized periodic discharges (LPDs) ( = 0.085). The two groups were matched for age and sex by case-control matching, and 25 cases in each group were successfully matched. Patients with neurosyphilis were more likely to have temporal epileptiform discharges than those with viral encephalitis ( = 0.002), and there were no significant differences in LPDs ( = 0.077) and SE ( = 0.088) between two groups.
When EEG shows temporal epileptiform discharges, especially in the form of LPDs, we should consider the possibility of neurosyphilis.
神经梅毒（NS）在临床和影像学特征上缺乏特异性，患者出现癫痫发作时常被误诊为病毒性脑炎。本研究旨在比较这两种疾病所致癫痫发作患者的脑电图（EEG）情况，为鉴别诊断提供指导。
对2012年至2020年厦门大学附属中山医院神经内科诊断为神经梅毒和病毒性脑炎且伴有癫痫发作的患者进行回顾性研究。
共纳入39例由神经梅毒引起癫痫发作的患者和40例由病毒性脑炎引起癫痫发作的患者。卡方检验分析显示，与病毒性脑炎患者相比，神经梅毒患者主要为中老年患者（<0.001），更易出现颞叶癫痫样放电（<0.001），发生癫痫持续状态（SE）的可能性较小（=0.029）。两组在侧方周期性放电（LPDs）的脑电图表现上存在差异（=0.085）。通过病例对照匹配使两组在年龄和性别上相匹配，每组成功匹配25例。神经梅毒患者比病毒性脑炎患者更易出现颞叶癫痫样放电（=0.002），两组在LPDs（=0.077）和SE（=0.088）方面无显著差异。
当脑电图显示颞叶癫痫样放电，尤其是呈LPDs形式时，应考虑神经梅毒的可能性。
