动态脑电图论文：24小时动态脑电图在脑性瘫痪患儿中的应用价值探讨.doc

动态脑电图论文：24小时动态脑电图在脑性瘫痪患儿中的应用价值探讨【中文摘要】24小时动态脑电图(AEEG)在脑性瘫痪患儿中的应用价值,了解脑性瘫痪患儿的24小时动态脑电图与脑瘫型别、脑瘫类型及癫痫等并发症之间的关系。方法以山东大学齐鲁儿童医院康复中心2008年10月至2009年10月收入院的165例脑瘫患儿为研究对象,按国际10/20系统放置头皮电极,组成8个导联用火棉胶固定于头皮,后连接记录盒,对165例脑性瘫痪患儿行24h长程描记。在监测期间,家长详细记录监测中的各项活动,睡眠情况及临床发作时间和症状,次日取回记录盒由脑电图专业人员对结果进行分析。其中76例患儿同时行常规脑电图检查,对脑瘫患儿24小时动态脑电图和常规脑电图异常率及痫样放电检出率进行比较。结果1.165例脑瘫患儿AEEG异常率为52.12%。76例脑瘫患儿AEEG与常规EEG检查相比较,AEEG异常率及痫样放电检出率高于常规EEG(2=9.70,P0.01；2=13.40,P0.01)。2.痫样放电出现在睡眠期(97.29%)多于清醒期(75.68%),且以非快速眼动睡眠、期为主。3.脑瘫各类型之间AEEG异常率痉挛型偏瘫最高(76.00%),其次为痉挛型四肢瘫(66.67%),不随意运动型AEEG异常率最低(11.11%)(2=34.20，P0.01)。4.脑瘫合并癫痫发作类型以全身性发作(55.56%)占多数。5.脑瘫合并癫痫组AEEG异常率、痫样放电的检出率高于未合并癫痫组(x2=28.86,P0.01；x2=58.52,P0.01).6.脑瘫合并精神发育迟滞组AEEG异常率高于未合并精神发育迟滞组(2=55.12,P0.01)。结论1.24小时动态脑电图对脑性瘫痪有着重要的应用价值。2.24小时动态脑电图可提高脑性瘫痪患儿痫样放电的检出率。3.脑性瘫痪患儿的痫样放电主要发生于非快速眼动睡眠、期。4.脑瘫患儿的动态脑电图异常率与其脑损伤部位有关。5.脑瘫患儿合并癫痫的发作类型及24小时动态脑电图改变多符合全身性发作的特点。6.脑瘫患儿合并癫痫或精神发育迟滞时24小时动态脑电图异常率较高。【英文摘要】To explore the application value of 24 hours ambulatory Electroencephalography (AEEG) monitoring in children with cerebral palsy. To explore the relations between the AEEG and the type,the class, epilepsy or other complications of children with cerebral palsy.MethodsWe conducted a clinical study based on 165 children with cerebral palsy referred to the Rehabilitation Center of Qilu Children s Hospital of Shandong University from October 2008 to October 2009.A11 the 165children with cerebral palsy were examined by the monitoring of 24 hours AEEG. The AEEG was recorded on a 8-channel AEEG system, Electrodes were attached to the scalp with collodion according to the 10-20 system, and the childs head was wrapped to decrease the likelihood of electrode displacement. A diary was completed by the parent to register the specific time, duration, and clinical description of any event.76 cases were undergoing both AEEG and EEG inspection,and their manifestation were read by one and the same Electroencephalographic Technologists.Results1. AEEG abnormalities were seen in 52.12% of 165 children with cerebral palsy. Of the 76 cases which undergoing both AEEG and EEG inspection,the positive finding of abnormality rate and epileptiform discharge by AEEG was obviously higher than routine EEG(x2=9.70,P0.01; x2=13.40, P0.01).2. The time of epileptiform discharges were mainly during sleeping (97.29%).3. Significant difference of AEEG abnormal rate was found in various clinical types of cerebral palsy (x2=34.20,P0.01).The highest AEEG abnormality rate was spastic hemiplegia (76.00%),followed by spastic quadriplegia (66.67%), dyskinetic was the lowest (11.11%).4. Generalized seizures were the most common (55.56%) clinical type of seizures in children with cerebral palsy.5. There was a significant difference in the abnormality rate and epileptiform discharge of AEEG between children with Seizures group and Seizure-free group (X2=28.86, P0.01; x2=58.52, P0.01).6. AEEG abnormalities were seen higher in children with mental retardation group than children without mental retardation group(x2=55.12, P0.01).Conclusions1.24 hours ambulatory Electroencephalography has very important application value in children with cerebral palsy.2.24 hours ambulatory Electroencephalography can increase the detection rate of epileptiform discharges.3. Children with cerebral palsy epileptiform discharges happened mainly during NREM-.4. The positive finding of abnormality rate in children with cerebral palsy by AEEG is related with the location of cerebral injury.5. The most of the clinical attack and AEEG characters of CP children with EP are Generalized seizures. 6. The abnormal AEEG rate of the children with cerebral palsy which complicated with epilepsy or mental retardation was higher.【关键词】动态脑电图 脑性瘫痪 诊断 康复【英文关键词】Electroencephalograph