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有报道指出全面性惊厥性癫痫发作(Generalized convulsive seizures,GCS)后出现短暂性高血氨症(Transient hyperammonemia,THA),没有足够的证据证实与癫痫的关系。文章的目的是确定发作后THA是否可以区分不同类型的发作,如使用视频脑电图(VEEG)监测确认脑电变化。在前瞻性队列中,筛选了所有进入癫痫监测单元并同意接受研究的成年患者(>18岁)。血氨的基础值以及在发作(所有患者)的60 min内、发作后24 h(只要有可能)的血氨水平均被检测。根据VEEG,将患者进行分组,分别为GCS、心因性惊厥性非痫性发作(Psychogenic nonepileptic seizures with convulsions,PNES-C)或局灶性癫痫发作(Focal seizures,FS)。使用描述性统计和参数/非参数方法分析数据。纳入患者78例,13例为GCS、8例为FS、9例为PNES-C。这些组在性别(P=0.04)和血氨基础值(P=0.02)方面是不同的,但年龄无差异。三组之间发作后血氨水平较血氨基础值的变化差异有统计学意义(P=0.004)。区分GCS与其他组差异的发作后血氨水平ROC曲线下面积为0.88[95%CI(0.69,0.96)],表明检测血氨水平是一种很好的用来区分GCS与其他发作的试验。血氨水平≥80μmol/L可以准确为80%的患者分类(灵敏度53.9%,特异性100%)。VEEG监测为THA与GCS癫痫发作之间的关联提供了客观证据,并为今后关于确定发作后血氨水平作为GCS的廉价诊断试验作用的研究奠定了基础。
There are reports of transient hyperammonemia (THA) following generalized convulsive seizures (GCS), and there is not enough evidence to confirm the relationship with epilepsy. The purpose of the article is to determine whether THA can distinguish between different types of seizures after the onset of attack, such as the use of video-electroencephalography (VEEG) monitoring to confirm EEG changes. In the prospective cohort, all adult patients (> 18 years old) who entered the epilepsy monitoring unit and agreed to the study were screened. The baseline value of blood ammonia and blood ammonia levels within 60 minutes of onset (all patients), whenever possible, at 24 hours post seizure were tested. According to VEEG, patients were grouped into GCS, Psychogenic nonepileptic seizures with convulsions (PNES-C) or focal seizures (FS). Analyze the data using descriptive statistics and parametric / non-parametric methods. 78 patients were included, 13 were GCS, 8 were FS, and 9 were PNES-C. These groups were different in gender (P = 0.04) and blood ammonia base (P = 0.02), but there were no differences in age. The difference of blood ammonia level between the three groups after the onset of attack was statistically significant (P = 0.004). The area under the ROC curve for blood ammonia levels after the onset of postoperative sepsis, which differentiated GCS from other groups, was 0.88 [95% CI (0.69, 0.96)], indicating that testing for blood ammonia levels is a good test to distinguish between GCS and other seizures. Blood ammonia levels ≥80μmol / L can be accurately classified as 80% of patients (sensitivity 53.9%, specificity 100%). VEEG monitoring provides objective evidence of the association between THA and GCS seizures and lays the foundation for future studies to determine the role of post-episode ammonia levels as a cheap diagnostic test for GCS.