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Objective:To explore the value of video-electroencephalography (VEEG) combined with amplitude-integrated electroencephalography (aEEG) in evaluating the condition and prognosis of neonatal hyperbilirubinemia brain injuries.Methods:A total of 120 children with hyperbilirubinemia treatedin the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2019 to July 2020 were enrolled. According to MRI with or without T 1 weighted imging (T 1WI) hyperintensity changes in the globus pallidus, they were divided into the brain injury group (52 cases) and the normal group(68 cases). According to the severity of brain injury, the brain injury group was divided into bilirubin encephalopathy group (23 cases) and subclinical bilirubin brain injury group (29 cases). According to the scores of Gesell Development Scale, the brain injury group was divided into good prognosis group (37 cases)and poor prognosis group (15 cases). The diagnostic value in brain injury with hyperbilirubinemia, the evaluation of the severity of brain injury and the predictive value of VEEG and aEEG were analyzed. Results:The abnormal rates of VEEG and aEEG in the brain injury group were higher than those in the normal group: 76.92% (40/52) vs. 8.82% (6/68), 80.77% (42/52) vs. 11.76% (8/68), the differences were statistically significant ( χ2 = 57.81 and 57.73, P<0.01). The abnormal rates of VEEG and aEEG in bilirubin encephalopathy group were higher than those in subclinical bilirubin brain injury group: 91.30% (21/23) vs. 65.52% (19/29), 95.65% (22/23) vs. 68.97% (20/29), the differences were statistically significant ( χ2 = 4.80 and 5.88, P<0.05). There was no significant difference in abnormal rates of VEEG and aEEG between the good prognosis group and poor prognosis group ( P>0.05). The results of operating characteristic curve analysis showed that the areas under the curve of VEEG combined with aEEG in the diagnosis of brain injury with hyperbilirubinemia, evaluation of the severity of brain injury, predicting the prognosis of children were higher than those of each examination method used alone ( P<0.05). Conclusions:VEEG combined with aEEG has diagnostic value for neonatal brain injury with hyperbilirubinemia, and has evaluation value for severity and prognosis of the disease.
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Objective:To evaluate the middle cerebral artery blood flow velocity in children with electrical status epileptic during sleep (ESES) by transcranial Doppler (TCD)-video electroencephalography (VEEG), and analyze its clinical significance.Methods:The clinical data of 40 children with ESES (ESES group) in Zhangjiakou First Hospital of Hebei Province from January 2019 to January 2021 were retrospectively analyzed. The mean flow velocity of middle cerebral artery (MCA mean) and middle cerebral artery (MCA) flow fluctuation value during deep sleep were measured by TCD-VEEG, and the results were compared with 40 healthy children (healthy control group) during the same period. The relationship between MCA mean, MCA flow fluctuation value during deep sleep and clinical characteristics was analyzed by multivariate stepwise regression. Results:The MCA mean and MCA flow fluctuation value during deep sleep in ESES group were significantly higher than those in healthy control group: (17.87 ± 7.38)% vs. (2.07 ± 1.11)% and (92.92 ± 21.64) cm/s vs. (58.11 ± 8.04) cm/s, and there were statistical differences ( t = 13.389 and 9.536, P<0.01). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with benign epilepsy with central temporal spinous wave (16 cases), benign epilepsy variant with central temporal spinous wave (13 cases) and acquired epileptic aphasia (11 cases) ( P>0.05). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with multifocal epileptic foci (16 cases), bilateral asymmetric epileptic foci (16 cases) and bilateral synchronous symmetric epileptic foci (8 cases)( P>0.05). The MCA flow fluctuation value during deep sleep in children with absolute synchronization and fully generalized ESES (16 cases) was significantly higher than that in children with asymmetric ESES (24 cases): (22.37 ± 2.37)% vs. (15.37 ± 5.37)%, and there was statistical difference ( t = 4.890, P<0.01); there was no statistical difference in MCA mean during deep sleep between 2 types of children ( P>0.05). The MCA flow fluctuation value during deep sleep in children with non obvious cognitive impairment (14 cases), mild cognitive impairment (13 cases) and severe cognitive impairment (13 cases) was (14.21 ± 5.20)%, (17.97 ± 7.45)% and (22.10 ± 7.94)%, and there was statistical difference ( F = 4.376, P<0.05); there was no statistical difference in MCA mean during deep sleep in 3 types of children ( P>0.05). Multivariate stepwise regression analysis result showed that the MCA flow fluctuation value during deep sleep had positive correlation with the degree of cognitive impairment in children with ESES ( r = 0.391, P<0.05). Conclusions:The fluctuation value of MCA during deep sleep by TCD-VEEG examination is positively correlated with the degree of cognitive impairment in children with ESES, which may be a reliable way for clinical evaluation of the degree of cognitive impairment in children with ESES.
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Objective To investigate the electro-clinical features of epilepsy with eye closure sensitivity (ECS).Methods The electroencephalograph database was searched using ECS during half a year period from January to June 2017 in Xijing Hospital.The duration of the follow-up was one year.Results Fifty-one patients diagnosed as epilepsy with ECS were investigated.Patients were classified into four epilepsy syndromes:33 with eyelid myoclonia with absences (EMA);13 with juvenile myoclonia epilepsy (JME);two with epilepsy with generalized tonic-clonic seizure on awakening and three with idiopathic occipital lobe epilepsy (IOE).The duration of the epileptiform discharges (EDs) triggered by eye closure (ECL) lasted more than five seconds in four patients with EMA and one patient with IOE.The EDs triggered by ECL were more frequent (85.2± 11.4 vs 37.5± 12.6,t=12.399,P=0.000) and lasting longer ((4.3± 1.9) s vs (2.3±0.8) s,t=3.585,P=0.001) in EMA than in JME.Conclusions ECS is common in EMA.The frequency and duration of the EDs triggered by ECL are helpful for identifying EMA and JME.
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Resumen Objetivo: Evaluar la utilidad del V-EEG en el diagnóstico diferencial de la epilepsia en un hospital pediátrico de nivel terciario durante el año 2015 Materiales y Métodos: Se realizó un estudio descriptivo sobre 90 pacientes evaluados en esta unidad durante el año 2015. Se recogieron datos de variables relacionadas con la indicación y los resultados del V-EEG, los cuales fueron analizados usando medidas de estadística descriptiva. Resultados: El 53,3% de los pacientes fueron masculinos. El promedio de edad es de 7,7 años con una desviación estándar de 4,7 años. El tiempo que transcurre desde la primera crisis hasta que el paciente acude a realizarse el V-EEG presenta una media de 4,3 años. 72 pacientes (80%) presentaron crisis epilépticas, 12 pacientes (13,3%) presentaron trastornos paroxísticos no epilépticos, mientras 6 niños (6,7%) no presentaron crisis durante el monitoreo. En el 93,3% de los casos el estudio fue exitoso. Conclusiones: Se demuestra la utilidad del monitoreo V-EEG para el diagnóstico diferencial de epilepsia.
Summary Objective: The aim was to evaluate the V-EEG usefulness in the differential diagnosis of epilepsy in a Third Level Children's Hospital during 2015. Materials and Methods: A descriptive study was performed over 90 patients in this unit during 2015. The data was obtained from variables related to indications and results of V-EEG, which were analyzed using descriptive statistics. Results: Fifty three percent of the patients were male. The mean age was 7.7 years (SD ± 4.7 years). The time measured between the first seizure and the V-EEG recording was 4,3 years. Seventy two patients (80%) had epileptic seizures, 12 patients (13,3%) had nonepileptic seizures, while six children (6.7%) had no seizures during the V-EEG monitoring. Ninety three percent of all recordings were successful. Conclusions: It was demonstrated the usefulness of V-EEG monitoring for the differential diagnosis of epilepsy.
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Objective To discuss the clinical features of non-conclusion seizures(NCS)in infants less than 1 -year-old,and the diagnostic and differential diagnostic value of video electroencephalography (VEEG).Methods A total of 30 NCS patients were took the regular electroencephalography at the first 20 minutes before VEEG monitoring which continued 2 to 4 hours in order to compare the differences between the two monitoring methods,then all patients were taken follow-up after one month,two months,and three months.Results Three cases attacks(accounting for 10.0%)were found by regular electroencephalograph-y,while 23 attacks(accounting for 76.7%)were found by VEEG following no epileptic discharge,either.All patients were found to be corporality NCS,having no psychogenic NCS,among which,19 patients(accounting for 63.3%)were non epileptic tonic-closure seizures,including 2 patients always keeping eyes staring at somewhere,2 patients gritted teeth or grinned,1 patient often put head back,1 patient stretched the neck or necking down,2 patients shrug his shoulders,9 patients shook head,and another 2 always put forth his strength, with or without stiffness,limb jitter,or made face red;on the other,7 patients (accounting for 23.3%)were benign myoclonus,another 4(accounting for 13.3%)were benign non epileptic infant spasm,no other types were found.Nobody had any antiepileptic therapies,15 of them have no more attacks in less than one month,7 in two months,1 in three months,and another 7 appeared occasionly under the conditions of great happiness,extreme an-ger or been raged.Conclusion VEEG have irreplaceable diagnostic and differential diagnostic value in infants less than 1 -year-old with NCS,and play an important role in monitoring the development of NCS.
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Objective To evaluate the clinical efficiency of intermittent photic stimulation (IPS) with pattern and red color plastic plates in video-electroencephalography(EEG).Methods Three hundred and fifty-eight patients hospitalized in Wuhan Children's Hospital from March 2013 to March 2014 were selected,and they were examined by using stroboscope with a red plastic plate,a dots printed plastic plate,and ordinary white flicker for photic driving response (PDR),photoparoxysmal responses (PPR),photoconvulsive response (PCR).The results of patients with PDR,PPR,PCR were analyzed.Results The PDR synchronously evoked by the three flickering patterns were in 29 cases,and the amplitude of photic drivings evoked by ordinary white flicker and red flicker were higher than that of flickering dot pattern [(30.294 ± 7.767) μV,(31.103 ± 8.920) μV vs (24.436 ± 8.075) μV],and there were significant differences(t =2.983,2.815,P =0.003,0.008).However,there was no significant difference between ordinary white flicker and red flicker (t =0.368,P =0.710).The PPR evoked were in 17 cases,and 16 cases (94.12％) of them were evoked by red color,while 10 cases (58.82％) wcre evoked by white light,and 1 case only evoked by flickering dot pattern.However,stronger intensity and longer duration time of PPR were evoked by red color than by white light.In 3 patients with positive PCR,the epileptic seizure was more likely to be evoked by red color or pattern plastic plate.Conclusions IPS with red and pattem plastic plate is more potent in eliciting photosensitive epilepsy in video-EEG than the ordinary white light.Moreover,it could reduce the discomfort of eyes without influencing PDR in comparison to the ordinary white light.
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Objective To investigate the Video?Electroencephalography(VEEG)characteristics and abnormal rate among healthy elderly. Meth?ods According to the age,120 healthy elders were divided into groups A,B,and C. Group A has 57 subjects,aged 60?69 years old;group B has 42 people,aged 70?79 years;group C has 21 individuals,aged≥80 years. Chi square and Rank sum test were used to calculate abnormal rate of VEEG. Additionally,characteristics of alpha、slow wave and Iconic sleep wave were analyzed. Result The total abnormal rate of VEEG was 42.5%, and it was particularly high(76.2%)among elderly over 80s. Frequency,amplitude,reactivity of Alpha wave and alpha index decreased as age in?creased. Theta slow wave increased as age increased,abnormal frontal area theta showed an increase among elderly over 80 s. Each sleep cycle iconic sleep wave was gradually decreased in the elderly. No statistical difference was found about sleep spindles and vertex sharp among different groups . Positive occipital sharp transients of sleep(POSTS)decreased as age increased. There was no POSTS among elderly over 80 s. Conclusion Our re?sults showed that abnormal rate is increased in the elderly,while reactivity variation,slow alpha frequency,alpha amplitude,alpha index are de?creased. In addition,the slow waves in frontal area is increased,. sleep cycles becomes less distinct,and the typical wave are decreased.
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La epilepsia tiene una incidencia de 1 % en la población, de los cuales un tercio no responde al tratamiento farmacológico, que conlleva a discapacidad y morbilidad secundaria. Los pacientes con epilepsia refractaria requieren un estudio multidisciplinario para el origen de la epilepsia y realizar la resección quirúrgica. En cinco pacientes del Hospital Almenara hicimos la evaluación clínica, neuropsicológica, estudio estructural con resonancia magnética, PET y SPECT y videoelectroencefalografía de cuero cabelludo e intracraneal, con lo que realizamos la cirugía resectiva correspondiente. En 71 % de los pacientes se logró la supresión completa de las crisis epilépticas y en 29 % restantes, la disminución de la frecuencia en 75 %. La morbilidad adicional en los pacientes operados fue leve y manejable. El manejo multidisciplinario y tratamiento quirúrgico de la epilepsia refractaria en el hospital Almenara es altamente eficaz y se requiere la implementación de una unidad de Cirugía de Epilepsia.
Epilepsy has 1 % prevalence, until one third are refractory to pharmacological treatment, so it produces disability, morbidity and mortality. These patients requires multidisciplinary diagnostic approach to localize the origin and ideally resect it. In Almenara Hospital, seven patients has been studied clinically, neuropsychologically, brain imaging: structure magnetic resonance and functional with positron emission tomography and single photon emission computed tomography and video electroencephalography non invasive initially and electrocorticography. After the study we decided and performed respective surgery. In 71 % of patients we have got complete suppression of seizures and in the remain 29 %, more than 75 % in seizure frequency. The side effects were mild and possible to treat. The multidisciplinary approach and surgical treatment of refractory epilepsy in the Almenara Hospital is highly efficient and it is needed to install an Specialized Unit.
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Humans , Male , Female , Electroencephalography , Epilepsy , Epilepsy/surgery , Neuropsychological TestsABSTRACT
Objective To evaluate the efficiency of long-term video electro-encephalography(VEEG) monitoring in neonatal seizure.Methods The medical records of 36 neonates recruited and performed with long-term VEEG in the neonatal intensive care units in hospital from Jun.2011 to Jun.2012 were collected.The medical records included age,gender,diagnosis,VEEG background,epileptiform activity,epileptic seizures (electrographic seizures,electroclinical seizures or both),and nonepilepic events.Informations on prognosis and therapy was also obtained.Results Among the 36 neonates,the neonates with normal,or mildly,moderately,and severely abnormal VEEG were 3 (8.3％),9 (25.0％),16 (44.4％) and 8 (22.2％) neonates,respectively.Children with normal electro-encephalography (EEG) developed normally.The percentage with developmental delay in children with mildly,moderately,and severely abnormal EEG were 1 1.1％,37.5％ and 62.5％,respectively and abnormal VEEG was significantly associated with developmental delay(x2 =13.8,P =0.003).Among these 36 neonates,21 cases had neonatal seizures (58.3％),including 14 (66.7％) cases with epileptic seizures and 6(28.6％) cases with nonepileptic seizures and 1 case with both.In addition,13 (61.9％) cases out of 21 cases with neonatal seizures developed abnormally (including developmental delay and death),and there was no significant association between neonatal seizure and development (x2 =0.206,P =0.65).Conclusions Neonatal seizure is very common,but electroclinical dissociation is an outstanding feature of neonatal seizures.Long-term VEEG monitoring is a valuable tool and may aid in the early identification and management of patients who are more likely to develop epilepsy.
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SIRPIDs, an acronym for stimulus-induced rhythmic, periodic, or ictal discharges, were first named in 2004. This is a pattern observed in continuous electroencephalogram (CEEG) consistently elicited by stimulation in comatose patients. The pathophysiology of SIRPIDs probably involves dysregulation of subcortico–cortical projections, particularly thalamocortical circuit, in a markedly abnormal brain with hyperexcitable cortex. This may explain some studies found an association of prolonged periodic epileptiform discharges (PEDs) activity and a higher incidence of concurrent electrographic seizures and SIRPIDs. An association of SIRPIDs and poor prognosis has already been described. However, it is not yet possible to assert whether these discharges can cause neuronal injury or if they are simply a marker of severe brain injury. Objective of this paper is to review clinical relevance and pathophysiology of SIRPIDs, as well as its role as a brain response in the critically ill patient.
O termo SIRPIDs é um acrônimo do inglês que pode ser traduzido como: descargas ictais, periódicas ou rítmicas induzidas por estímulos e foi utilizado pela primeira vez em 2004. Este padrão é observado no eletroencefalograma contínuo (CEEG) obtido pela estimulação de pacientes comatosos. A fisiopatologia dos SIRPIDs provavelmente envolve uma falha na regulação das projeções corticais e subcorticais, particularmente nos circuitos talamocorticais, num cérebro anormal com o córtex hiperexcitável. Isso pode explicar a associação encontrada por alguns estudos entre as descargas epileptiformes periódicas (PEDs) prolongadas e uma maior incidência de crises eletrográficas, bem como de SIRPIDs. É descrita associação entre os SIRPIDs e pior prognóstico. Ainda não é possível determinar se estas descargas podem causar dano neuronal ou se elas são simplesmente marcadoras de lesão cerebral grave. O objetivo deste artigo é revisar a relevância clínica, a fisiopatologia dos SIRPIDs e seu papel como resposta cerebral no paciente crítico.