动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究

魏钰; 但炜; 陶园; 孙超; 谢延风; 石全红; 詹彦; 孙晓川

doi:10.16016/j.1000-5404.201810089

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动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究

临床医学 | 更新时间：2026-01-09

- 动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究
- Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy
- 第三军医大学学报 2019年41卷第5期页码：461-466
- 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：
  
  [但炜，E-mail: 1187403442@qq.com DAN Wei, E-mail: Dan_Wei@sina.com.cn
- 基金信息：
  
  国家临床重点专科建设项目经费资助((2011)170号);重庆市卫生局重点课题(2012-1-008)
- DOI：10.16016/j.1000-5404.201810089
  中图分类号： R651.110.6;R741.044;R742.101
- 收稿：2018-10-16，
  
  修回：2018-12-19，
  
  纸质出版：2019-03-15
- 稿件说明：
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魏钰, 但炜, 陶园, 等. 动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究[J]. 第三军医大学学报, 2019,41(5):461-466.

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.
魏钰, 但炜, 陶园, 等. 动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究[J]. 第三军医大学学报, 2019,41(5):461-466. DOI： 10.16016/j.1000-5404.201810089.

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

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