Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy

Yu WEI; Wei DAN; Yuan TAO; Chao SUN; Yanfeng XIE; Quanhong SHI; Yan ZHAN; Xiaochuan SUN

doi:10.16016/j.1000-5404.201810089

您当前的位置：

首页 >

文章列表页 >

Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy

Clinical Medicine | 更新时间：2026-01-09

- Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy
- Journal of Third Military Medical University Vol. 41, Issue 5, Pages: 461-466(2019)
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院神经外科
- 作者简介：
- 基金信息：
  
  the National Clinical Key-discipline Construction Program of China((2011)170号);the Key Project of Chongqing Municipal Health Bureau(2012-1-008)
- DOI：10.16016/j.1000-5404.201810089
  CLC： R651.110.6;R741.044;R742.101
- Received：16 October 2018，
  
  Revised：2018-12-19，
  
  Published：15 March 2019
- 稿件说明：
移动端阅览
Yu WEI, Wei DAN, Yuan TAO, et al. Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy[J]. Journal of Third Military Medical University, 2019, 41(5): 461-466.
DOI：

Yu WEI, Wei DAN, Yuan TAO, et al. Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy[J]. Journal of Third Military Medical University, 2019, 41(5): 461-466. DOI： 10.16016/j.1000-5404.201810089.

摘要

目的

回顾性分析神经外科开颅术后预防性抗癫痫药停药后癫痫发作与未发作患者的动态脑电图(ambulatory electroencephalogram，AEEG)特点，定性、定量分析AEEG不同波形与癫痫发作的关系，探讨AEEG对预防性抗癫痫药物减停的指导价值。

方法

选取我院神经外科2010年至2017年颅脑疾病开颅术后预防性抗癫痫用药停药后癫痫发作的166例患者(发作组)，同期按年龄、性别、病因、部位与发作组相近比例分层选取的方法选取166例未发作的患者(对照组)，随访时间为1~8年，分析两组的脑电图资料。参照Hughes J R根据慢波、棘尖波量的差异制定的分类方法，分为R型(rare，少量型)、R-M型(rare-moderate

少-中量型)、M型(moderate，中量型)、M-L型(moderate-large，中-大量型)、L型(large，大量型)；NS型(no sharp waves，无棘尖波)、RS型(rare sharp waves，少量)、MS型(moderate sharp waves，中量)和LS型(large sharp waves，大量)。根据慢波出现方式分为3型:S型(scattered，散在性)、F型(focal，局灶性)、P型(paroxysmal同步阵发或暴发性)。分别比较两组停药前的脑电波差异。发作组根据再次服药后癫痫发作能否被控制分为控制组和未控制组，比较两组棘尖波数量之间的差异。

结果

① 发作组和对照组患者的脑电图类型构成比差异有统计学意义(

0.01)。从慢波数量上分析，发作组中以M型为主，对照组以R型为主，发作组中M、M-L、L型患者共91例(91/166，54.8%)显著高于对照组(14.5%)；从慢波出现形式分析，发作组中以P型为主，对照组以S型为主，发作组中P型患者共107例(107/166，64.4%)显著高于对照组(34.3%)；从棘尖波数量差异分析，发作组以MS型为主，对照组以RS型为主，发作组中MS、LS型患者共116例(116/166

69.8%)显著高于对照组(22.9%)。M型、M-L型、L型及P型慢波，MS、LS型棘尖波为停药后癫痫发作的高危波形(OR＞1)。②再次服药后，控制组中人数随棘尖波从RS型至LS型而逐渐减少，而未控制组人数逐渐增多。

结论

M、M-L、L型慢波，P型慢波，MS、LS型棘尖波为神经外科开颅术后预防性应用抗癫痫药停药后癫痫发作的高危波形，AEEG对神经外科开颅手术患者预防性应用抗癫痫药物的减停有一定的指导价值。

Abstract

Objective

To retrospectively analyze the characteristics of ambulatory electroencephalogram (AEEG) in postcraniotomy patients

with epileptic seizures and without seizures after reduction of preventive antiepileptic drugs

and qualitatively and quantitatively investigate the relationship between AEEG waveforms and seizures

in order to explore the guiding value of AEEG for the reduction of prophylactic antiepileptic drugs.

Methods

A total of 166 postcraniotomy patients with epileptic seizures after discontinuation of prophylactic antiepileptic drugs admitted in our department from 2010 to 2017 were recruited and subjected to seizure group in this study. Another 166 postcraniotomy patients without seizure who have the similar proportions in age

gender

etiology

location with the seizure group in our department during the same period served as non-epileptic seizure group. The 2 groups of patients were followed up for 1 to 8 years. Referring to the classification of Hughes J R

we divided them into following types: R type (rare)

R-M type (rare-moderate)

M type (moderate)

M-L type (moderate-large)

L type (large)

NS type (non-sharp spike)

RS type (rare sharp spike)

MS type (moderate sharp spike)

and LS type (large sharp spike). The waves were also assigned into S type (scattered)

F type (focal)

and P type (paroxysmal) according to the appearance of slow waves. The differences of AEEG waveforms were compared between the 2 groups before the discontinuation of prophylactic antiepileptic drugs. The seizure group was further divided into a controlled subgroup and a non-controlled subgroup according to whether the epilepsy be controlled after taking the drugs again. The number of spike-wave between the 2 subgroups was compared.

Results

① Significant differences presented in AEEG type composition ratio between the patients in the seizure group and non-epilepsy seizure group (

0.01). The main type was M-type in the seizure group

and R-type in the non-epilepsy seizure group. There were more patients (91/166

54.8%) with M

M-L and L types in the seizure group

significantly higher than the other group (14.5%). For the slow waves

the main type was P-type in the seizure group and S-type in the control

and there were 107 patients (107/166

64.4%) with P type in the former group

significantly higher than the other group (34.3%). For the number of spike-waves. The former group mostly had MS-type

while the control mainly had RS-type

and the patients with MS- and LS-type (116/166

69.8%) were larger than those in the control group (22.9%). The high-risk waveforms of seizures after discontinuation of prophylactic antiepileptic drugs were slow wave

s of M

M-L

P types and spike-waves of MS and LS types (OR

1). ②After taking the drugs again

the number of patients in the control group were gradually decreased from RS-type to LS-type

and the numbers in the uncontrolled group were gradually increased.

Conclusion

The high-risk waveforms for postcraniotomy seizures after discontinuation of anti-epileptic drugs are slow waves of M

M-L

L and P types and spike waves of MS and LS types. AEEG is of certain guiding value in the prevention and treatment of antiepileptic drugs in patients undergoing neurosurgical craniotomy.

关键词

Keywords

references

中国抗癫痫协会专家组.颅脑疾病手术后抗癫痫药物应用的专家共识(试行)[J].中华神经外科杂志, 2012, 28(7):751-754. DOI:10.3760/cma.j.issn.1001-2346.2012.07.034.China

Anti-epilepsy Association Expert Group. Expert consensus on the application of antiepileptic drugs after surgery for craniocerebral diseases (Trial)[J]. Chin J Neurosurg, 2012, 28(7):751-754. DOI:10.3760/cma.j.issn.1001-2346.2012.07.034.

黄永光, 曾惠良.脑卒中后癫痫的临床、影像学特点与预后分析[J].影像诊断与介入放射学, 2003, 12(3):142-143. DOI:10.3969/j.issn.1005-8001.2003.03.005.

HUANG Y G, ZENG H L, et al . Analysis of clinical & imaging characters and prognosis in patients with epilepsy after stroke[J ] . J Diagn Imaging Interv Radiol, 2003, 12(3):142-143. DOI:10.3969/j.issn.1005-8001.2003.03.005.

王学峰, 肖波, 孙红斌.难治性癫痫[M].上海:上海科学技术出版社, 2002:142-144.

WANG X F, XIAO B, SUN H B, et al . Refractory epilepsy[M ] . Shanghai: Shanghai Science and Technology Press, 2002:142-144.

HUGHES J R, WANG C C. The relationship between slow and sharp waves (spikes) and also clinical seizures[J]. Clin Electroencephalogr, 2002, 33(4): 165-170. DOI:10.1177/155005940203300406.

CSERCSA R, DOMBOVÁRI B, FABÓ D, et al . Laminar analysis of slow wave activity in humans[J ] . Brain, 2010, 133(9): 2814-2829. DOI:10.1093/brain/awq169.

方升, 但炜, 谢延风, 等.双侧同步节律性慢波在幕上肿瘤患者继发癫痫中的易感性研究[J].第三军医大学学报, 2011, 33(20):2191-2194.

FANG S, DAN W, XIE Y F, et al . Susceptibility of bilateral synchronous rhythmic slow wave in secondary epilepsy in patients with intracranial tumor[J ] . J Third Mil Med Univ, 2011, 33(20):2191-2194.

MASTROPAOLO C, TONDI M, CARBONI F, et al . Prognosis after therapy discontinuation in children with epilepsy[J ] . Eur Neurol, 1992, 32(3): 141-145. DOI:10.1159/000116811.

MATRICARDI M, BRINCIOTTI M, BENEDETTI P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy[J]. Epilepsia, 1989, 30(5): 582-589. DOI:10.1111/j.1528-1157.1989.tb05476.x.

TANG L, XIAO Z. Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: A meta-analysis[J]. Clin Neurophysiol, 2017, 128(2): 297-302. DOI:10.1016/j.clinph.2016.11.024.

TREMBLAY G F. The Prefrontal Cortex: Anatomy, Physiology, and Neuropsychology of the Frontal Lobe (2nd Ed.)[J]. Neurology, 1989, 39(7): 1008-1008. DOI:10.1212/wnl.39.7.1008.

KANEMURA H, HATA S, AOYAGI K, et al . Serial changes of prefrontal lobe growth in the patients with benign childhood epilepsy with centrotemporal spikes presenting with cognitive impairments/behavioral problems[J ] . Brain Dev, 2011, 33(2): 106-113. DOI:10.1016/j.braindev.2010.03.005.

KANEMURA H, MIZOROGI S, AOYAGI K, et al . EEG characteristics predict subsequent epilepsy in children with febrile seizure[J ] . Brain Dev, 2012, 34(4): 302-307. DOI:10.1016/j.braindev.2011.07.007.

PAMPIGLIONE G. Current practice of clinical electroencephalography[J]. J Neurol, Neurosurg Psychia, 1980, 43(6): 559-559. DOI:10.1136/jnnp.43.6.559.

MCCORMICK D A, CONTRERAS D. On the cellular and network bases of epileptic seizures[J]. Annu Rev Physiol, 2001, 63: 815-846. DOI:10.1146/annurev.physiol.63.1.815.

DUBE C M, RAVIZZA T, HAMAMURA M, et al . Epileptogenesis provoked by prolonged experimental febrile seizures: mechanisms and biomarkers[J ] . J Neurosci, 2010, 30(22): 7484-7494. DOI:10.1523/jneurosci.0551-10.2010.

LÉVESQUE M, AVOLI M. The kainic acid model oftemporal lobe epilepsy[J]. Neurosci Biobehav Rev, 2013, 37(10 Pt 2): 2887-2899. DOI:10.1016/j.neubiorev.2013.10.011.

CURIA G, LONGO D, BIAGINI G, et al . The pilocarpine model of temporal lobe epilepsy[J ] . J Neurosci Methods, 2008, 172(2): 143-157. DOI:10.1016/j.jneumeth.2008.04.019.

KRENDL R, LURGER S, BAUMGARTNER C. Absolute spike frequency predicts surgical outcome in TLE with unilateral hippocampal atrophy[J]. Neurology, 2008, 71(6): 413-418. DOI:10.1212/01.wnl.0000310775.87331.90.

ROSATI A, AGHAKHANI Y, BERNASCONI A, et al . Intractable temporal lobe epilepsy with rare spikes is less severe than with frequent spikes[J ] . Neurology, 2003, 60(8): 1290-1295. DOI:10.1212/01.wnl.0000058761.12715.0e.

CHAUVIÈRE L, DOUBLET T, GHESTEM A, et al . Ch anges in interictal spike features precede the onset of temporal lobe epilepsy[J ] . Ann Neurol, 2012, 71(6):805-814. DOI: 10.1002/ana.23549.

GONCHAROVA Ⅱ, ALKAWADRI R, GASPARD N, et al . The relationship between seizures, interictal spikes and antiepileptic drugs[J ] . Clin Neurophysiol, 2016, 127(9): 3180-3186. DOI:10.1016/j.clinph.2016.05.014.

BRITTON J W. Significance of the EEG and epileptiform abnormalities in antiepileptic drug discontinuance[J]. J Clin Neurophysiol, 2010, 27(4): 249-254. DOI:10.1097/WNP.0b013e3181eaa620.

PAVLOVIĆ M, JOVIĆ N, PEKMEZOVIĆ T. Withdrawal of antiepileptic drugs in young patients with cryptogenic focal epilepsies[J]. Seizure, 2012, 21(6): 431-436. DOI:10.1016/j.seizure.2012.04.008.

SKOW A, DOUGLAS I, SMEETH L. The association between Parkinson's disease and anti-epilepsy drug carbamazepine: a case-control study using the UK General Practice Research Database[J]. Br J Clin Pharmacol, 2013, 76(5): 816-822. DOI:10.1111/bcp.12100.

LI W, SI Y, ZOU XM, et al . Prospective study on the withdrawal and reinstitution of antiepileptic drugs among seizure-free pa tients in west China[J ] . J Clin Neurosci, 2014, 21(6): 997-1001. DOI:10.1016/j.jocn.2013.09.019.

VERROTTI A, D'EGIDIO C, AGOSTINELLI S, et al . Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse[J ] . Eur J Paediatr Neurol, 2012, 16(6): 599-604. DOI:10.1016/j.ejpn.2012.02.002.

PAVLOVI M, JOVIĆ N, PEKMEZOVIĆ T. Antiepileptic drugs withdrawal in patients with idiopathic generalized epilepsy[J]. Seizure, 2011, 20(7): 520-525. DOI:10.1016/j.seizure.2011.03.007.

SU L, DI Q, YU N, et al . Predictors for relapse after antiepileptic drug withdrawal in seizure-free patients with epilepsy[J ] . J Clin Neurosci, 2013, 20(6): 790-794. DOI:10.1016/j.jocn.2012.07.010.

OLMEZ A, ARSLAN U, TURANLI G, et al . Risk of recurrence after drug withdrawal in childhood epilepsy[J ] . Seizure, 2009, 18(4): 251-256. DOI:10.1016/j.seizure.2008.10.011.

廖兴甫, 但炜, 孙超, 等.头皮脑电图波型对动脉瘤性蛛网膜下腔出血继发癫痫的预测价值[J].第三军医大学学报, 2018, 40(15):1383-1388. DOI: 10.16016/j.1000-5404.201712273.

LIAO X F, DAN W, SUN C, et al .Predictive value of scalp electroencephalogram patterns for secondary epilepsy after aneurysmal subarachnoid hemorrhage[J ] . J Third Mil Med univ, 2018, 40(15):1383-1388. DOI: 10.16016/j.1000-5404.201712273.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Value of ambulatory electroencephalogram in evaluation of postoperative withdrawal of antiepileptic drugs in patients with glioma-related epilepsy

Altered expression of clusterin and stathmin2 in epileptic patients and rats

Epilepsy secondary to focal cortical dysplasia: a clinical report of 38 children

Predictive value of scalp electroencephalogram patterns for secondary epilepsy after aneurysmal subarachnoid hemorrhage

Changes of dendritic spine morphology and functions in the development of epilepsy in rats

Related Author

Xinyi LIANG

Wei DAN

Daifen JIANG

Huan LIAN

Xin LI

Yanfeng XIE

Quanhong SHI

Yan ZHAN

Related Institution

Department of Neurosurgery, Children's Hospital of Chongqing Medical University

Department of Neurology, Children's Hospital of Chongqing Medical University

Department of Radiology, Children's Hospital of Chongqing Medical University

Department of Pathology, Children's Hospital of Chongqing Medical University

Department of Neurology, Second Affiliated Hospital of Chongqing Medical University

⁰