VEEG监测中睡眠剥夺对小儿癫痫的诊断研究

doi:10.19854/j.cnki.1008-2425.2022.02.0009

摘要/Abstract

摘要： 目的应用视频脑电图(video electroencephalography,VEEG)监测中睡眠剥夺试验,对小儿癫痫患者视频脑电图分析研究。方法选取我院2019年1月至2022年2月,功能神经外科癫痫门诊明确诊断为癫痫的患者52例,并将其按照病程和年龄匹配后,进行回顾性研究,随机分成两组,一组为观察组,另一组为对照组,两组患儿一般临床资料统计学分析无差异性。观察组患儿在进行VEEG监测过程中进行睡眠剥夺试验,全程记录时间为4小时。对照组患儿选择常规。VEEG监测,全程记录时间同样为4小时。对比两组患儿的监测的阳性检出率,同时比较两种脑电图对癫痫样放电的诊断效能指标(灵敏度和漏诊率)。结果观察组26例患儿检测出 22 例脑电图异常波(84.62%) ,其中有明显癫痫诊断的脑电图波形患儿21例( 阳性检出率80.78%) ;对照组26例患儿检测出14例脑电图异常波(54.85%) ,其中有明显癫痫诊断的脑电图波形患儿13例( 阳性检出率50.00%)。观察组的VEEG异常率、阳性检出率均高于对照组,差异显著(P＜0.05)。剥夺睡眠视频脑电图对痫样放电诊断的灵敏度80.78%高于常规组的50.00%(P<0.05),漏诊率19.22%低于常规组电图的50.00%,差异显著(P＜0.05)。结论应用VEEG监测中睡眠剥夺试验,与常规VEEG监测癫痫患儿,能够提高癫痫患儿脑电图阳性率,降低漏诊率和误诊率,检测效果显著,为癫痫患儿正确诊断及时治疗提供可靠依据,具有较好的临床应用价值。

关键词: VEEG, 睡眠剥夺, 癫痫患儿, 诊断

Abstract: Objective To analyze the video EEG of children with epilepsy by using the sleep deprivation test in video electroencephalography (VEEG) Methods From January 2019 to February 2022,52 patients with epilepsy were selected from the epilepsy clinic of functional neurosurgery.They were matched according to the course of disease and age.They were randomly divided into two groups.One group was the observation group and the other group was the control group.There was no difference in the statistical analysis of general clinical data between the two groups.The observation group received sleep deprivation test during VEEG monitoring,and the whole recording time was 4 hours.The children in the control group chose routine.VEEG monitoring,the whole process recording time is also 4 hours.The positive detection rate of monitoring was compared between the two groups,and the diagnostic efficacy indexes (sensitivity and missed diagnosis rate) of two kinds of EEG for epileptiform discharge were compared. Results In the observation group,22 abnormal EEG waves (84.62%) were detected in 26 children,including 21 children with obvious epilepsy diagnosis (80.78%); In the control group,14 abnormal EEG waves (54.85%) were detected in 26 children,including 13 children with obvious epilepsy diagnosis (the positive detection rate was 50.00%).The abnormal rate and positive detection rate of VEEG in the observation group were significantly higher than those in the control group (P<0.05).The sensitivity of sleep deprivation video EEG in the diagnosis of epileptiform discharges was 80.78% higher than 50.00% in the conventional group (P<0.05),and the missed diagnosis rate was 19.22% lower than 50.00% in the conventional group (P<0.05) . Conclusion Sleep deprivation test in VEEG monitoring and routine VEEG monitoring of epileptic children can improve the positive rate of EEG in epileptic children,reduce the rate of missed diagnosis and misdiagnosis,and the detection effect is significant.It provides reliable basis for correct diagnosis and timely treatment of epileptic children,and has good clinical application value.

Key words: VEEG, Sleep deprivation, Children with epilepsy, Diagnosis

中图分类号:

R742.1

张妮娜, 汪恩焕, 周钟阳, 陈伟强, 王宏伟, 裴士文, 李慕涵, 王进进, 侯永强, 高鹏程. VEEG监测中睡眠剥夺对小儿癫痫的诊断研究[J]. 立体定向和功能性神经外科杂志, 2022, 35(2): 107-111.

Zhang Nina, Wang Enhuan, Zhou Zhongyang, et al. Diagnostic study of sleep deprivation in VEEG monitoring for childhood epilepsy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(2): 107-111.

参考文献

[1] 李世绰,等.《临床诊疗指南癫痫病分册》[M].北京:人民卫生出版社,2016:1.
[2] 凌至培,汪业汉,等.立体定向和功能神经外科学[M]北京:人民卫生出版社,2018:213.
[3] 通悦,郑维红.癫痫与认知功能障碍研究进展[J].中国全科医学,2017,20(15):1818.
[4] 赵秀梅,王睿君.头颅 CT 检查小儿癫痫的诊断价值[J].内蒙古医科大学学报,2018,40(3):34~36.
[5] 陈凤平.部分剥夺睡眠在癫痫患儿动态脑电图检测中的应用[J].现代医学,2019,47(5):570~573.
[6] 应薇娜,夏梦婕,任震宇,等.睡眠期脑电图异常对癫痫患者认知功能影响的随访研究[J].癫痫与神经电生理学杂志, 2019,28(4):209~212.
[7] 吴辉.论儿童癫痫诊断中睡眠剥夺脑电图应用研究[J].青海师范大学学报( 自然科学版) ,2017,33(1):94~96.
[8] 叶世武.2 小时睡眠剥夺脑电图在脑卒中后癫痫诊断中的应用研究[J].中国现代医药杂志,2017,19(6):71~72.
[9] 王万弟,何仲义,孙涛,等.视频脑电图、表面肌电图和心电图同步监测对诊断小儿癫痫运动性发作类型及鉴别发作性疾病的价值[J].宁夏医科大学学报,2017,39(3):336.
[10] 高玉娜.睡眠剥夺在癫痫患儿视频脑电图监测中的应用价值[J].全科护理,2019,17(12):1497~1498.
[11] 谢莉萍,喻韬,罗蓉,等.0~6 岁儿童脑电检查剥夺睡眠时间与监测质量的关系[J].世界最新医学信息文摘,2019,19(67): 49~51.
[12] Thijs RD,Surges R,OBrien TJ,et al.Epilepsy in adults[J].Lancet.2019,393(10172):689~701.
[13] Van Der Lende M,Arengs JB,Lamberts RJ,et al.The yield of long-term electrocardiographicrecordings in refractory focal epilepsy[J].Epilepsia,2019,60 (11): 2215~2223.
[14] Juhasz C,John F.Utility of MRI,PET,and ictal SPECT in presurgicalevaluation of non-lesional pediatric epilepsy[J].Seizure,2020,77:15~28.
[15] Wagner JL,Modi AC,Guilfoyle SM,et al.Current behavioral health and cognitive screening practices inpediatric epilepsy[J].Epilepsy Behav,2019,101 ( PT A) :106214.
[16] 雷东.剥夺睡眠脑电图与动态脑电图诊断小儿癫痫的价值[J].医疗装备,2019,32(12):29~30.
[17] 杨丽.癫痫诊断中睡眠剥夺和药物诱导睡眠脑电图的临床应用价值探析[J].临床研究,2018,26(2):85~87.
[18] 陈盛植.氟桂利嗪治疗小儿癫痫的疗效及其对MDRlmRNA表达的影响[J].医学临床研究,2017,34(3):587.
[19] 王瑞芳,刘光丽,刘安娜,等.小儿复杂部分性癫痫中剥夺睡眠脑电图的诊断价值分析[J].世界睡眠医学杂志,2019,6(8):1101~1102.
[20] 韩洁,平莉莉,胡丽敏,等.原发性癫痫患儿脑电图与血清炎性因子水平的相关性分析[J].河北医科大学学报,2017,38(1):51.
[21] Diessen EV,Otte WM,Braun K PJ,et al.Does sleep deprivation alter functional EEG networks in children with focal epilep[J].Frontiers in Systems Neuroscience,2014,29(5):67.
[22] 叶世武.2小时睡眠剥夺脑电图在脑卒中后癫痫诊断中的应用研究[J].中国现代医药杂志,2017,19(6):71~72.
[23] 高艳琼,延华,金瑞瑞,等.150例儿童脑电图睡眠顶尖波特点的初步探讨[J].陕西医学杂志,2016,45(4):450.
[24] 俊梅,胡国峰,刘妍.剥夺睡眠脑电图与常规脑电图对小儿癫痫的诊断价值[J].中国实验诊断学,2019,23(3):497~498.
[25] 刘帅.剥夺睡眠脑电图在小儿癫痫诊断中的应用[J].甘肃医药,2020,39(1):53~55.
[26] 郑晓红,李璐,宋鑫.剥夺睡眠并特殊脑电图检查对疑似癫痫患者的应用[J].现代电生理学杂志,2015,22(1):33~34.
[27] 逯霞,艾克拜尔·哈里克,许健,等.视频脑电图监测对脑瘫合并癫痫发作性患儿的早期诊断及预后价值[J].立体定向和功能性神经外科杂志,2017,30(2):68~71.
[28] 杨丽.癫痫诊断中睡眠剥夺和药物诱导睡眠脑电图的临床应用价值探析[J].临床研究,2018,26(2):85~87.
[29] 蒋莎,吴照,陈波.视频脑电图监测在脑瘫合并癫痫患儿中的应用[J].临床医学工程,2015,22(12):1566~1567.
[30] Alix JJP,Kandler RH,Pang C,et al.Sleep deprivationand melatonin for inducing sleep in paediatric electroencephalography:aprospective multicentre service evaluation[J].Dev Med Child Neurol,2019,61(2):181~185.
[31] Zaiwalla Z.Sleep deprivation versus melatonin to induce sleep duringpaediatric electroencephalography[J].Dev Med Child Neurol.2019,61(2):114~115.
[32] 简荣林.剥夺睡眠脑电图在小儿癫痫发作诊断中的价值[J].分析仪器,No.5 Sept.2021,115~118.
[33] 刘宗瑞.睡眠剥夺脑电图检测对小儿癫痫的诊断价值及其影响因素分析[J].中国药物与临床,2021,21(16):2782~2784.