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Analysis of EEG among 2 357 healthy people in Beijing area

ObjectiveNumerous foreign researches focused on the changes of EEG during the developmental periods from the newborn to late adulthood. However, the EEG changes of healthy Chinese people is still rare. Therefore, we examined the EEG of 2 357 healthy Chinese people.MethodsIn 1982, guided by Prof. Feng, we analysed the waking EEG of 2 357 healthy people, from 2 to above 60 years old, including open eyes induction test and hyperventilation.ResultsAt age 2 ~ 4, the posterior basic rhythms has reached 8 ~ 9 Hz, but the rhythms were unregular pattern. After age 7, the rhythms were 9 Hz, α index was more than 60%, the amplitude was higher than other ages. At age 12 ~ 14, the main rhythms was 10 Hz, the same as adulthood, α index was 70% ~ 80%. After this age, the amplitude of α rhythm deceased gradually. Above 60 years old, the main rhythm was 9 Hz, α index <60%, the amplitude was lower than adulthood. At age 14 ~ 16, the θ index in frontal and temporal regions was 6%, the same as the adulthood. At age 18 ~ 20, β index was 20%.ConclusionsIn the article, we analyzed the waking EEG of 2 357 healthy Chinese people in Beijing area. Although this multi-center study was accomplished at 1980s, the data is still of great value to the clinical EEG today.

轻度皮质发育畸形伴少突胶质细胞增生及癫痫（MOGHE）—一个新的临床组织病理学实体

2002年Burger等首先报道癫痫患者的大脑标本中有少突胶质细胞增生。2013年Coras等认为是一个新的临床病理学实体称之增殖性少突胶质细胞伴癫痫（Proliferative oligodendroglial hyperlasia in epilepsy，POGHE）。2017年Schurr等详细研究其病理学后确认为轻度皮质发育畸形伴少突胶质细胞增生及癫痫（Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy，MOGHE）。迄今国外文献报道92例，国内尚无报道及介绍，本文对92例进行分析并复习文献。均为儿童药物难治性部分发作，发作年龄≤15岁者96.4%，≤10岁者83.1%。临床表现多种多样。电临床多定位于额叶（81.5%），少数在颞顶或颞枕区。磁共振成像异常类似于局灶性皮质发育不良（Focal cortical dysplasia，FCD），尤其是FCDⅡa。均为药物难治性癫痫，并做外科切除性治疗。组织病理学均有不同于FCD的特点，即灰白质交界处有簇状或层状少突胶质细胞增生及异位神经元。但皮质分层无异常。

在常规表面电极脑电图检测中慎用“表面蝶骨电极”

癫痫内科医生在癫痫术前评估中应具备的条件和应起的作用

癫痫发作的报警与预警

癫痫是一种最常见的神经系统疾病，特点为多数发作无诱因且难以预测。发作可导致合并症，包括外伤及癫痫猝死（Sudden unexpected death in epilepsy，SUDEP），并致生活质量下降。过去20年广泛研究了发作的预警和报警，开发很多方法及设备，如头皮脑电图、颅内脑电图、肌电图、皮肤电变化、心率和心率变异性（Heart rate variability，HRV）。其中HRV是最有前景的方法。发作发放通过网络导致交感神经和副交感神经间不平衡并且改变了自主神经发放合并心率异常。过去20年用计算机方法开发了HRV的谱分析。HRV的变化早于脑电图发作和临床发作的开始。HRV可能是癫痫发作的预警和报警的指标。现在虽有很多关于癫痫的HRV算法，但是缺少标准的对于癫痫患者的方案，并且没有固定的监测模式，使之难以转化为临床实用，解决这个问题是十分重要的。总结出一个HRV评估的最低方案可用于所有癫痫患者的研究十分必要，可使HRV成为预警癫痫发作的有用工具。

眶额区病变及脑脊膜膨出表现为颞叶内侧发作一例

眶额区癫痫--有待深入研究的癫痫类型

眶额区位于双侧额叶下方前颅凹中, 嗅束将直回与其他脑回分开。眶额区本身在各脑回间, 以及与额叶凸面及内侧面, 颞叶有广泛的联系。眶额区起源的癫痫少见。发作开始均先出现动作停止、无反应及茫然, 而后根据扩布的不同出现:嗅觉异常、过度运动、头眼偏向同侧或对侧、重复动作等运动症状、自主神经症状, 还可以有难以确定的感觉异常、发笑、似曾相识、视幻觉、自动症。根据临床症状可以分为额叶型、颞叶型及额颞叶型。头皮脑电图很难提供有定位价值的异常, 常为额颞叶甚至双侧额颞叶异常。深部电极尤其是立体脑电图有定侧定位价值。眶额区癫痫几乎均为药物难治性癫痫, 应以外科治疗为主。

The role of magnetoencephalography in presurgical focus localization in epilepsy

Intracranial electrographic recording, especially stereoencephalography (SEEG), remains the gold standard for preoperative localization in epilepsy patients. However, this method is invasive and has low spatial resolution. In 1982, magnetoencephalography (MEG) began to be used in epilepsy clinics. MEG is not affected by the skull and scalp, can provide signals with high temporal and spatial resolution, and can be used to determine the epiletogensis zone (EZ) and the seizure onset zone (SOZ). Magnetic source imaging (MSI) is a method that superimposes the MEG data on a magnetic resonance image (MRI) and has become a major tool for presurgical localization. The applicability of MEG data has been largely improved by the development of many post-MRI processing methods in the last 20 years. In terms of the sensitivity of localization, MEG is superior to VEEG, MRI, PET and SPECT, despite inferiority to SEEG. MEG can also assist in the intracranial placement of electrodes and improve preoperative planning. Limitations of MEG include high cost, insensitivity to radiation source, and difficulty in locating deep EZ in the medial regions of the brain. These limitations could be overcome by new generations of equipment and improvement of algorithmics.

强制正常化（Forced normalization）—一种特殊的发作，脑电图和精神病的相关性

癫痫发作和精神症状之间有拮抗现象，即发作消失及脑电图明显改善后出现精神症状，1953 年 Landolt 称之为强制正常化（Forced normalization）。至今报道尚不多。机制仍待研究。可能诱因为抗癫痫药物或癫痫外科治疗，尤其是颞叶切除。应用抗精神病药物后大多数精神症状消失，如不积极治疗可能成为持续性精神症状。因此值得重视。

顶叶内侧—解剖、生理与癫痫

顶叶内侧主要包括楔前叶、后扣带皮质及压后皮质，为默认网络的关键部位，其功能尚未完全了解，与空间认知，记忆及图形方向的认知有关，并参与意识过程。顶叶内侧癫痫极为少见，又因起源于顶叶内侧面，因此对其特征，诊断标准的研究不多。主要分为两大类型：① 楔前叶癫痫，楔前叶与其他皮质区及皮质下结构有广泛的联系，可分为三部分：前感觉运动亚区、中认知亚区、后感觉亚区。发作症状包括前庭症状、视觉症状，还有运动症状；② 后扣带回癫痫，发作时有四种症状：过度运动、不对称性强直性姿势、自动症及呆滞发作。上述症状多数为发作发放扩布至其他脑区后出现的。头皮脑电图无定位价值，仅有颅内电极尤其是立体定向脑电图才能确定致痫区。绝大部分为药物难以控制发作者，一旦确诊外科治疗为最佳选择。