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目的通过分析难治性癫痫患者全面性抽搐发作(generalized convulsive seizures,GCS)的临床和视频脑电图资料,探讨影响发作后全面脑电抑制(postictal generalized EEG suppression,PGES)发生的临床因素。方法回顾性分析于我院神经外科2010年9月至2015年7月就诊的57例难治性癫痫患者96次GCS的临床和视频脑电资料。比较PGES(+)与PGES(-)患者在性别、年龄、病因、致痫灶部位和GCS的发作频率、症状类型、持续时间、觉醒状态、吸氧等方面的差异,探讨影响PGES发生的临床因素。结果 24例(42.1%)患者36次(37.5%)GCS后出现PGES,持续(45.4±38.5)s。颞叶癫痫比颞叶外癫痫PGES出现率高(70.6%vs 26.7%,P=0.03);PGES的出现率在双侧对称强直伸展型GCS中比单纯阵挛型GCS和不对称强直型GCS高(48.2%vs 13.3%vs 28.0%,P=0.02);在睡眠中发作比清醒中高(47.1%vs 26.7%,P=0.04);在发作后朦胧静止状态比自由活动状态高(45.6%vs 0,P<0.01);在发作后早期吸氧比不吸氧低(20.6%vs 46.8%,P=0.01)。PGES(+)的发作比PGES(-)的发作平均强直持续时间长[(10.7±6.6)vs(7.7±2.1)s,P=0.03],而性别、年龄、病因、GCS发作频率与PGES的发生没有关联(P>0.05)。结论颞叶癫痫、双侧对称强直伸展型GCS、睡眠中发作和发作后朦胧静止状态更易出现PGES,而发作后早期吸氧可降低PGES的发生。
Objective To investigate the clinical factors that influence the postictal generalized eEG suppression (PGES) after clinical and video EEG data of patients with generalized convulsive seizures (GCS) in patients with intractable epilepsy. Methods The clinical and video EEG data of 96 GCSs in 57 patients with refractory epilepsy from September 2010 to July 2015 in our department of neurosurgery were retrospectively analyzed. The differences of PGES (+) and PGES (-) patients in gender, age, etiology, epileptic foci and GCS seizure frequency, symptom type, duration, wakefulness, factor. Results PGES occurred in 36 patients (37.5%) after GCS in 24 patients (42.1%) for 45.4 ± 38.5 s. The incidence of PGES in temporal lobe epilepsy was higher than that in temporal lobe epilepsy (70.6% vs 26.7%, P = 0.03). The incidence of PGES in bilateral symmetrical straightened GCS was higher than that in simple clonoid GCS and asymmetric straight GCS (48.2% vs 13.3% vs 28.0%, P = 0.02). The onset of seizures was higher in sleep than in conscious (47.1% vs 26.7%, P = 0.04); the hazy state of rest was higher than that of free activity (45.6% vs 0 , P <0.01). Early oxygenation was lower than non-oxygenation after the episode (20.6% vs 46.8%, P = 0.01). The duration of PGES (+) episodes was longer than that of PGES (-) episodes (10.7 ± 6.6 vs 7.7 ± 2.1 s, P = 0.03), while the gender, age, etiology, frequency of GCS seizures and PGES There was no association (P> 0.05). Conclusions Temporal lobe epilepsy, bilaterally symmetrical and straight stretches of GCS, PGES are more likely to occur during the onset of sleep and post-seizure hazyness, while the early stage of episode of oxygen may decrease the occurrence of PGES.