| Objective We analyzed and summarized the characteristics of long-term electroencephalogram(LEEG)of post-stroke epilepsy,which may be helpful to the early diagnosis and evaluation of post-stroke epilepsy.Methods The study included patients with at least two epileptic seizures at two weeks after stroke who were admitted to the Department of Neurology,General Hospital,Tianjin Medical University from December 2014 to December 2017.All patients had a definite history of stroke and were confirmed by head CT or/and MRI.All patients had completed LEEG examination(8hVEEG,24 hAEEG,24hVEEG).And general data(name,sex,time of stroke,type of stroke,location of stroke,head CT or/and MRI findings,etc)and epileptic-related data(time of first and second seizures after stroke,frequency of epileptic seizures after stroke,epilepsy manifestations,the time and results of LEEG examination,drug treatment and so on)were collected.An electronic medical record management system was established and analyzed and summarized in a retrospective way.The detection rates of interictal abnormal and epileptiform waves were analyzed.The characteristics of LEEG waveform,distribution mode and abnormal wave in interictal period were summarized.When epileptogenic foci were comprehensively analyzed according to the LEEG during the interictal period and stroke lesions and the clinical neurological signs,the consistency between epileptiform discharge area during EEG and stroke lesions was analyzed,and the results were as follows: consistent,partially consistent,inconsistent and unable to locate.The detection rate of epileptiform waves in the periods of only awake,only sleep,awake and sleep was analyzed and compared,and the sleep-wakefulness pattern of epileptiform discharges of interictal LEEG in patients with post-stroke epilepsy was analyzed.The detection rate of epileptiform waves of sphenoidal electrode and scalp electrode was compared and the influence of sphenoidal electrode on epileptiform waves detection rate was analyzed.The data were analyzed by SPSS22.0 software.Results According to the inclusion and exclusion criteria,63 cases with post-stroke epilepsy were included.Through the statistical analysis of the interictal LEEG,theresults showed that:(1)In 63 patients with post-stroke epilepsy,the detectable rate of interictal abnormal waves was 92.06%(58/63),that of normal EEG was 7.94%(5/63),and that of epileptiform waves was 74.60%(47/63).(2)The abnormal EEG waveforms of 58 cases showed that epileptiform discharges accounted for 81.03%(47/58)and only slow wave activity accounted for 18.97%(11/58).The difference between them was statistically significant(P<0.05).EEG distribution mode of 58 patients with abnormal waves detected showed that focal epileptiform discharges accounted for 72.41%(42/58),generalized epileptiform discharges accounted for8.62%(5/58),focal slow waves accounted for 17.24%(10/58)and widespread slow waves accounted for 1.72%(1/58).There was significant difference between focal epileptiform discharges and other EEG discharge modes(P<0.05).Abnormal wave manifestations of abnormal EEG in 58 cases showed that focal epileptiform discharges with focal slow waves accounted for 44.83%(26/58),focal epileptiform discharges accounted for 25.86%(15/58),focal epileptiform discharges with widespread slow waves accounted for 1.72%(26/58),generalized epileptiform discharges accounted for 3.45%(2/58),generalized epileptiform discharges with widespread slow waves accounted for 5.17%(3/58),focal slow waves accounted for17.24%(10/58)and widespread slow waves accounted for 1.72%(1/58).There was significant difference between focal epileptiform discharges with local slow waves and other abnormal EEG waves(P<0.05).(3)In 47 cases of epileptiform waves,15cases(31.91%)were found to have the same epileptiform discharge area as the imaging stroke lesions,18 cases(38.30%)were partially consistent,9 cases(38.30%)were not consistent,5 cases(10.64%)were unable to locate,and 5 cases(10.64%)were unable to locate.The total consistency(consistency and partially consistency)between the epileptiform discharge area and the imaging stroke lesions in 47 patients with epileptiform waves was 70.21%(23/47).There was significant difference between total consistency(consistency and partially consistency)and inconsistency(P<0.05).(4)62 cases of 63 patients with LEEG were recorded in the awake period and the sleep period.In 62 patients,only 14 epileptiform waves were detected in awake period,4 epileptiform waves were detected in sleep period and 26 epileptiform waves were detected in both awake and sleep periods.The detection rate ofepileptiform waves during awake period and sleep period > that of epileptiform wave only in awake period > that in sleep period only had statistical significance(P<0.05);The detectable rate of epileptiform waves in awake period was 64.52%(40/62)and that in sleep period was 48.39%(30/62).There was no significant difference in the detection rate of epileptiform waves between awake period and sleep period(P>0.05).(5)The sphenoidal electrode was recorded in 31 cases of the 63 patients.The detection rate of epileptiform waves in scalp electrode was 77.42%(24/31)in 31 patients,the detection rate of epileptiform waves in scalp electrode and sphenoidal electrode was87.10%(27/31).There was no significant difference between them(P > 0.05).The stroke lesions with epileptiform waves by sphenoidal electrode were mainly involved in frontal lobe and frontotemporal lobes(21/31).Conclusions 1.The detection rates of abnormal and epileptiform waves of LEEG in patients with post-stroke epilepsy are high.Therefore,we should improve the LEEG as far as possible in the diagnosis,differential diagnosis and evaluation of post-stroke epilepsy.2.Epileptiform discharges is the main waveform of interictal LEEG in patients with post-stroke epilepsy and epileptiform discharges may be a predictor of the recurrence and progression of post-stroke epileptic seizures into post-stroke epilepsy.3.Focal epileptiform discharges is the main distribution mode of interictal LEEG in patients with post-stroke epilepsy and local epileptiform discharges may be a evidence that an uninduced epileptic seizures are diagnosed as post-stroke epilepsy.4.Abnormal waves of interictal LEEG in patients with post-stroke epilepsy are mainly characterized by focal epileptiform discharges with focal slow waves,Epileptiform discharges suggest that there are local epileptic damage,which can be used to locate the epileptiform area,while slow waves can reflect the degree of brain function injury to some extent and is helpful to evaluate the prognosis of patients.5.The total consistency(consistency and partially consistency)between the epileptiform discharge area and the imaging stroke lesions in patients with post-stroke epilepsy was 70.21%.Therefore,LEEG can be used in the localization of epileptogenic foci,which is beneficial to the diagnosis and differential diagnosis of post-stroke epilepsy.However,because of the conduction of brain waves,the localization of epileptogenic foci should be combined with the clinical symptoms andsigns of the patients.6.The interictal LEEG of post-stroke epilepsy was characterized by epileptiform waves in both awake and sleep periods,which might be related to the involvement of the frontal lobe and frontotemporal lobes in stroke lesions.Patients with post-stroke epilepsy is more likely to occur at night,we should pay special attention to the monitoring and nursing of patients at night.Moreover the detection rate of epileptiform waves could be increased by LEEG plus sleep period.Therefore,patients with post-stroke epilepsy who have been diagnosed or suspected of diagnosed should include awake and sleep periods when improving LEEG.7.LEEG plus sphenoidal electrode in post-stroke epilepsy can improve the detection rate of epileptiform waves in interictal time,especially in the lesions involving the frontal lobe and frontotemporal lobes. |
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