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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SeizureonsetwasdefinedasasustainedrhythmicchangeintheEEGaccompaniedbysubsequentclinicallytypicalse

izureactivity,atafrequencyof>2Hz,notexplainedbylevelofarousal,andclearlydistinguishedfrombackgroundEEGandintericta

lactivity.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,lowamplitu

dedischargesover10Hz(478seizuresfrom68patients）VelascoA,EngelJ,Plasticity,7:1-2,49-58,2000过度同步化放电：hypersynchro

nousactivitywithlowfrequency,high-amplitudespikeshavingafrequencyunder2Hz,andlastingmorethan5sec，whichencounteredmorefrequent

lythanthefirstpattern起源于颞叶的颅内电极发作起始表现形式直流电漂移：DirectCurrentshifting.Itwasshownthat89%oflow-voltagefast-typeseizurescontainedaninitialslow

wave,whereashypersynchronous-typeseizuresdidnotshowaninitialslowwave.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:3yearswithEngel’sI(a);IntracranialEEGOnset:RH2with18HzLVFwithi

nitialslow.iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee,Spencer(s),e

tal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity(sameastemporallobeseizure);②Rhythmicspikeorspike-waveactivity;③Rhythmicrounds

inusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity;ZhouQJ,F,24yrs,Ageofonset:3yrs,Seizuretype:Rfingerclonic→Rhand

dystonic→GTCS,iEEG:sameashypersynchronouspatternaftersurgeryfollow-up:2years,Engel’sI(b).Hypersynchronousfollowedbyfastactivity(28Hz)iEEGSeizure-Onse

tPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltag

efastactivity(sameastemporallobeseizure);②Rhythmicspikeorspike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespike

activity;ZhouH,F,17yrs,Ageofonset5yrs,seizuresemiology:sensoryaura→Larmtonic-clonic→Lunilateraltonic-clonic;iEEG4Hzthetarangeo

frhythmicspike-wave:aftersurgeryfollow-up:3yearswithEngelII.BFIG.4A.continuedSeizurefreerateinSpenser’s:rhy

thmicalpha-thetaspike(-wave)activity,andrhythmichigh-amplitudebetaspikeactivity,wereassociatedwithaseizure-freerateofonly6.3%(includ

ingonlyoneof16seizure-freepatients).iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextrat

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

spikeorspike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslowwaves;⑤High-amplitudespikeactivity;Rhythmicroundsinusoidalw

aves,inthealpha-thetarange.Thispatterndidnotshowanyspikeorsharpcomponet;YanM,F,33yrs,ageofonset5yrs,seizuresimiology:automotor(LOC)→G

TCS,aftersurgeryfollow-up:3monthswithEngel’sI(b)spreadingThesameseizurewithspreadingtocontralateralcorticalareaThesamepatient,seizureonset

showing5.6Hzthetawithroundsinusoidalwavewithatlefttemporalneocorticalcontacts.Schilleretal.suggestedthis

patternwiththeta-deltafrequency,asaremotepropagatedseizurepatternEpilepsia1998:39:380-388iEEGSeizure-O

nsetPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee,Spencer(s),etal.Epilepsia,41(3):297-307,2000①Low-vo

ltagefastactivity;②Rhythmicspikeorspike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslowwaves;Semirhythmicslowwaves<5Hz.Thispatternwa

snotveryrhythmicandhadnosharpcontours.⑤High-amplitudespikeactivity;extratemporalSemirhythmicslowwavesLiuML,M,19yrs,Seizuretypehypermotor→Larmtonic,i

EEGonset:D25,E1with4Hzslowonset;aftersurgeryfollow-up2year,havingseizuresaspresurgery.ABSemirhythmic

slowwavesLiuML,M,19yrs,Seizuretypehypermotor→Larmtonic,iEEGonset:D25,E1with4Hzslowonset;aftersurgeryfollow-up2

year,havingseizuresaspresurgery.iEEGSeizure-OnsetPatternsin53patients（266-Sz）withtemporalandextratemporalepilepsy---Lee,Sp

encer(s),etal.Epilepsia,41(3):297-307,2000①Low-voltagefastactivity;②Rhythmicspikeorspike-waveactivity;③Rhythmicroundsinusoidalwaves;④Semirhythmicslow

waves;⑤High-amplitudespikeactivity,high-amplitudebetaspikeactivity,notobservedinourgroup;⑥Lowvoltage

fastwithDCshift;goodindicationforsurgery.Lowvoltagefast(>80%)withDCshiftDurationofDCshiftshouldbeatleast3s.Amplitudefromp

eaktopeakvariedfrom200uVto>1mV.sunxiangjieDCshiftLowvoltagefast(>80%)withDCshiftIctalDCshiftsismainlysurface-negativeinpolarity,butithasnotbeenne

cessarily.Theycanprecede(1-3sin15%)orcoincidedwiththeconventionalictalEEGonset(in85%ofLVFseizures);DCshiftLowvoltagefast(>80%)withDCs

hiftDCshiftsareseeninamorerestrictedareashowingconvetionalictalEEGchanges,whichmayreflectepileptogenecity.Theiroccurren

ceoftencoincidedwiththeelectro-decrementalpatternandLVFactivity.DCshiftDCshiftingmayoccurwith“fastactivitydenovo”duringseizureevolut

ion,whichshouldbeconcernedaboutpresurgically.DCshiftDCshiftDCshiftcanbeseenintheseizuresoriginatedfrommesial-andneo-corticalregions.DCsh

iftingwouldnotsimultaneouslypresentasaninitialeventinthehypersynchronoustypeofEEGseizureonset.DCshiftA.Seizureonsetwithlowvoltagefastactivity

andDCshiftandhypersynchronouspatternrecordediniEEGaregoodindicationforepilepsysurgery;B.Otherwise,asustainedrhythmi

cchangeintheEEGaccompaniedbysubsequentclinicallytypicalseizureactivity,clearlydistinguishedfrombackgroundEEGandint

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