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发作期颅内电极脑电图表现形式王静，刘兴洲2014.09颅内电极脑电图发作起始SeizureonsetwasdefinedasasustainedrhythmicchangeintheEEGaccompaniedby

subsequentclinicallytypicalseizureactivity,atafrequencyof>2Hz,notexplainedbylevelofarousal,andclearlydistinguishedfrombackgroun

dEEGandinterictalactivity.癫痫发作起始脑电图：一种持续性脑电图改变，频率＞2Hz，明显不同于背景和间歇期脑电活动，排除不同水平的唤醒反应，伴有继之出现的典型临床发作。SpencerS,Epilepsia,1992,33(3):537-45起源于颞叶的颅内电极发作

起始表现形式低波幅快活动：low-voltagefast(LVF)becausetheEEGwasinitiallydesynchronized,consistingofhigh-frequency,lowamplitudedischargesover10Hz(478seizuresfrom68p

atients）VelascoA,EngelJ,Plasticity,7:1-2,49-58,2000过度同步化放电：hypersynchronousactivitywithlowfrequency,h

igh-amplitudespikeshavingafrequencyunder2Hz,andlastingmorethan5sec，whichencounteredmorefrequentlythanthefirstpattern起源于颞叶的颅内电极发作起始表现形式直流电漂移：DirectC

urrentshifting.Itwasshownthat89%oflow-voltagefast-typeseizurescontainedaninitialslowwave,whereashypersynchronous-typeseizuresdidnotshowani

nitialslowwave.RH1RH2RH3RH4起源于颞叶的颅内电极发作起始表现形式Sunxj,M,21yrs,Ageofonset:14yrs;Seizuretype:dialeptic→automotor.Postsurgicalfollow-up:3year

swithEngel’sI(a);IntracranialEEGOnset:RH2with18HzLVFwithinitialslow.iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporale

pilepsy---Lee,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity(sameastemporallobeseizure);②Rhyth

micspikeorspike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity;ZhouQJ,F,24yrs,Ageofonset:3yrs,Seizur

etype:Rfingerclonic→Rhanddystonic→GTCS,iEEG:sameashypersynchronouspatternaftersurgeryfollow-up:2years,Engel’sI(b).Hypersynchro

nousfollowedbyfastactivity(28Hz)iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee

,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity(sameastemporallobeseizure);②Rhythmicspikeorsp

ike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity;ZhouH,F,17yrs,Ageofonse

t5yrs,seizuresemiology:sensoryaura→Larmtonic-clonic→Lunilateraltonic-clonic;iEEG4Hzthetarangeofrhythmicspike-wave:aftersurge

ryfollow-up:3yearswithEngelII.BFIG.4A.continuedSeizurefreerateinSpenser’s:rhythmicalpha-thetaspike(-wave)activi

ty,andrhythmichigh-amplitudebetaspikeactivity,wereassociatedwithaseizure-freerateofonly6.3%(includingon

lyoneof16seizure-freepatients).iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporal

epilepsy---Lee,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity;②Rhythmicspikeorspike-waveactivity;③Rhyth

microundsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity;Rhythmicroundsinusoidalwaves,inthealpha-thetarange.Thispatterndidnotshow

anyspikeorsharpcomponet;YanM,F,33yrs,ageofonset5yrs,seizuresimiology:automotor(LOC)→GTCS,aftersurgeryfollow-up:3monthswithEn

gel’sI(b)spreadingThesameseizurewithspreadingtocontralateralcorticalareaThesamepatient,seizureonsetshowing5.6Hzthetawithrounds

inusoidalwavewithatlefttemporalneocorticalcontacts.Schilleretal.suggestedthispatternwiththeta-deltafrequency,asaremotepropagatedseizurepatt

ernEpilepsia1998:39:380-388iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee,Spencer(s),etal.Epil

epsia,41(3):297-307,2000①Low-voltagefastactivity;②Rhythmicspikeorspike-waveactivity;③Rhythmicroundsinuso

idalwaves;④Semirhythmicslowwaves;Semirhythmicslowwaves<5Hz.Thispatternwasnotveryrhythmicandhadnosharpcontours.⑤High-amplitudespikeacti

vity;extratemporalSemirhythmicslowwavesLiuML,M,19yrs,Seizuretypehypermotor→Larmtonic,iEEGonset:D25,E1with4Hzslowonset;aftersurgeryfollow-up2year,

havingseizuresaspresurgery.ABSemirhythmicslowwavesLiuML,M,19yrs,Seizuretypehypermotor→Larmtonic,iEEGonset:D25,E1with4

Hzslowonset;aftersurgeryfollow-up2year,havingseizuresaspresurgery.iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtempora

landextratemporalepilepsy---Lee,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity;②Rhythmicspikeorspike-waveactivity;③Rhythmicroun

dsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity,high-amplitudebetaspikeactivity,notobservedinourgroup;⑥LowvoltagefastwithDCshi

ft;goodindicationforsurgery.Lowvoltagefast(>80%)withDCshiftDurationofDCshiftshouldbeatleast3s.Amplitudefrompeaktopeakvariedfrom200uVto>1m

V.sunxiangjieDCshiftLowvoltagefast(>80%)withDCshiftIctalDCshiftsismainlysurface-negativeinpolarity,butit

hasnotbeennecessarily.Theycanprecede(1-3sin15%)orcoincidedwiththeconventionalictalEEGonset(in85%ofLVFseizures);DCshiftLowvol

tagefast(>80%)withDCshiftDCshiftsareseeninamorerestrictedareashowingconvetionalictalEEGchanges,whichmayreflectepileptogene

city.Theiroccurrenceoftencoincidedwiththeelectro-decrementalpatternandLVFactivity.DCshiftDCshiftingmayoccurwith“fast

activitydenovo”duringseizureevolution,whichshouldbeconcernedaboutpresurgically.DCshiftDCshiftDCshiftcanbeseenintheseizu

resoriginatedfrommesial-andneo-corticalregions.DCshiftingwouldnotsimultaneouslypresentasaninitialeventinthehypersynchronoustypeo

fEEGseizureonset.DCshiftA.SeizureonsetwithlowvoltagefastactivityandDCshiftandhypersynchronouspatternrecordediniEEGaregoodindicationforepilepsysu

rgery;B.Otherwise,asustainedrhythmicchangeintheEEGaccompaniedbysubsequentclinicallytypicalseizureactivity,clearlydistinguishedfrombackgroun

dEEGandinterictalactivity,remainthemajorconsiderationforpresurgicalresection.发作期颅内电极脑电图表现形式-小结