| Background and purpose: Epilepsy is a chronic disease due to the brain function disorder. BC 500 years or 700 years, the stone book found in Babylon, epilepsy have a clear record, but so far on the mechanism of epilepsy, diagnosis and treatment still exist many unresolved issues. For a presumption of epilepsy patient, we should address the following issues of the diagnosis: 1. Whether the paroxysmal symptoms is epileptic ones ?2. If it is epilepsy, is what type of seizure ? Whether is the special epilepsy syndrome ? 3. If it is epilepsy, is there an epileptic focus, whether evoked by factors, and what is the factor ? In the diagnosis of epilepsy, the biggest problem is mainly rely on history, but history isn't often detailed and precise enough, most of the physical examinations are normal, so we hope there are the special inspections. Cragar has compared methods for diagnosis of epilepsy such as history, paroxysmal symptoms, evoked test, serum PRL levels, video electroencephalogram (Video-EEG), SPECT, psychological tests, neuropsychological testing etc, the results showed that the diagnosis of VEEG was the highest accurate rate, the other methods only as the secondary diagnoses, which can not replace the electroencephalogram (EEG) in the diagnosis of epilepsy role. Therefore EEG is the most important inspection in diagnosis of epilepsy. Especially in recent years, EEG monitoring technology (24h portable EEG monitoring, video EEG monitoring etc) is widely used to provide further diagnosis of epilepsy reliability. Neural-imaging is mainly used to find the cause of epilepsy and to support the position of focal epilepsy, but can not be used as the basis for the diagnosis of epilepsy. Digital video EEG monitoring is the most effective method to identify the nature and type of seizures, and is one of the important bases to be commonly used by the international epilepsy and epilepsy syndrome for classification. It is now universal in the domestic apply, its advantage lies in simultaneously observing the paroxysmal symptoms and EEG changes, and realizes the unification of the video images, sound and EEG. It is difficult to replace the clinical value in the differential diagnosis of epilepsy, type and location.Through the digital long-term VEEG in the diagnosis of epilepsy, the purpose of this study was to investigate the problems in the epilepsy diagnosis, differential diagnosis and position, to raise the rates of diagnosed epilepsy and epileptic foci of positioning, and widely used in clinical.Methods: (1) To use the U.S. Glass-Telefactor EEG digital video monitoring system, transform the brain signals and images into digital data by disk records. For the reference to the international 10/20 system to be placed 20 scalp electrodes in patients, ears electrodes as the reference electrode and unrelated grounding electrode, with a single camera to monitor the seizure, by specific doctors to monitor patients in the specialized examination room. (2) Aug 06 to Mar 08 our hospital epilepsy out-patient, neurology and pediatric wards, 100 patients with preliminary epilepsy were consulted at random, both firstly monitored by routing-EEG (REEG) 20~30min, made integrated Hyperventilation, open and close eyes, flash stimulation etc evoked test, then by the digital long-term VEEG monitoring, record sphenoid electrode leads (5-6h) and under the state of awaking and sleeping were performed 24h. Repeatedly play back the recorded information, the specific doctors definite the conclusion. Use the statistical software of SPSS13.0 to analysis the related data byâ…¹2.Results: (1) The digital long-term VEEG monitor the 23 cases (23%) with clinical seizures and simultaneously epileptic discharge, REEG monitor 1 (1%), the digital long-term VEEG monitored the positive rate of epileptic seizures and discharge was significantly higher than the REEG (P <0.001); (2) The digital long-term VEEG monitoring 58 cases (58%) with interval epileptic-form discharges, REEG monitoring 29 cases (29%), the digital long-term VEEG monitored the positive rate of the interval epileptic-form discharges was higher than the REEG (P <0.001); (3) In 23 cases monitoring the clinical seizure and epileptic discharges, record 6 cases in awaking, 13 cases of sleeping, sleeping and awaking together recorded 4 cases, the monitoring of sleeping totally 17 cases (69.57%), the awaking period monitoring totally 10 cases (47.83%), the period of sleeping in monitoring the clinical seizure and the epileptic discharges detection rate increaser than the awaking period (P<0.05), sleeping monitoring the 17 cases found in non-rapid eye movement (NREM) sleep I,â…¡period. For 58 cases of the interval epileptic-form discharges patients, record 17 cases in awaking, 28 cases of sleeping, sleeping and awaking together recorded 13 cases, the monitoring of sleeping totally 41 cases (70.69%), awaking period monitoring totally 30 cases (51.72%), the period of sleeping in monitoring the interval epileptic-form discharges detection rate increaser than the awaking period (P<0.05). Of which 33 cases epileptic-form discharges in NREM sleep I,â…¡period, eight cases appeared in NREM sleep I,â…¡, and III,IV; (4) The digital long-term VEEG monitoring, sphenoid electrodes recorded 16 cases of side discharge, bilateral discharge eight cases, the non-sphenoid electrode recorded two cases side discharge, no record of bilateral discharge, REEG and non-sphenoid electrodes recorded one case of side discharge; (5) 100 cases of monitored patients, 23 cases (23%) to conformed the types of seizures, Of which five cases were re-classification of epilepsy, 20 cases (20%) were identified as diagnosis of epilepsy syndrome; (6) 18 cases(18%) were just clinical seizures unaccompanied synchronous abnormal discharge, and were defined non-epileptic seizures (NES); (7) 16 cases had no events recorded and no interictal epileptic-form abnormalities, resulting in no firm conclusion; (8) 3 cases were diagnosed as refractory epilepsy, by the pro-surgical the long-term VEEG monitoring the location, combining with the clinical manifestation, and neural imaging results, defined the focus of epileptic and eventually performed epilepsy surgery.Conclusions: The digital long-term VEEG monitoring can significantly increase the detection rate of epileptic-form discharges, play an important role in the epilepsy diagnosis and differential diagnosis, and provide an important basis for the seizure of type and location. |
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