The Applied Study Of Video-EEG In The Diagnosis And Localization Of Epilepsy

Objective:To explore the applied value of video EEG in the diagnosis,differential diagnosis, classification of epilepsy and the focus localization of preoperative epilepsy.Methods:The video EEG findings was analyzed in 252 patients with paroxysmal symptoms. The clinical seizure types,preoperative VEEG,intraoperative VEEG,postoperative VEEG and preoperative imaging positioning was analyzed in 35 patients with refractory epilepsy.Results:1:1.1 Attack case.323 clinical attacks were recorded in 133 patients.According to the history, symptoms and VEEG findings from interictal stage to ictal stage,patients were divided into three groups:the group of epilepsy including 193 patients,the group of non-epilepsy including 45 patients and the group of uncertainty including 14 patients.1:1.2 Definition of attack type.In the group of epilepsy,237 clinical seizures were recorded in 88 patients with clinical attacks, including 52 simple partial seizures,89 complex partial seizures,64 secondarily generalized seizures,25 absence seizures and 7 generalized tonic-ctonic seizures.During VEEG monitoring,96 seizures were recorded in sleeping and 141 seizures in awaking.For 88 patients with clinical seizures,21 seizures were recorded only in sleeping,30 seizures only in awaking and 37 seizures in sleeping and awaking.In the group of non-epilepsy,86 clinical attacks were recorded,including sleep disorders in 9 patients,children with tic disorders in 6 patients,dystonia after cerebral infarction in 5 patients and pseudoepileptic seizures in 25 patients.For all the non-epileptic seizures,14 of them were recorded in sleeping,which belong to sleep disorders,the rest of non-epileptic seizures were recorded in awaking.1:1.3 Definition of epilepsy and epileptic syndrome.26 cases were diagnosed as epileptic syndrome,by the history,symptoms and EEG findings in interictal stage and ictal stage,including benign epilepsy of childhood with central-temporal spikes in 15 patients,childhood absence epilepsy in 8 patients and Lennox-Gastaut syndrome in 3 patients.Definition of epilepsy type:frontal lobe epilepsy in 25 patients,temporal lobe epilepsy in 80 patients,occipital lobe epilepsy in 2 patients and parietal lobe epilepsy in 3 patients. 2:2.1 seizure types:134 clinical seizures were recorded in 34 patients,including 38 simple partial seizures,9 simple partial seizure evolving to generalized seizures,60 complex partial seizures and 27 complex partial seizure evolving to generalized seizures.Classification of epilepsy by seizure type and EEG:temporal lobe epilepsy in 22 patients,frontal lobe epilepsy in 8 patients,occipital lobe epilepsy in 2 patients and parietal lobe epilepsy in 3 patients.2:2.2 EEG of interictal stage:The main performance that follows:①focal epileptic wave(sharp wave,spike,slow sharp wave complex).②irregular slow wave with paroxysmal unilateral trend,irregular slow wave without paroxysmal unilateral trend.③paroxysmal former head of high-voltage slow wave rhythm④focal paroxysmal EEG low-voltage⑤increased slow wave in EEG background.From the EEG of interictal stage,we find 20 cases of side discharge,bilateral discharge 12 cases and 3 cases which are not clear.2:2.3.EEG of ictal stage:The performance of the initial period of discharge that fllows:①isolated focal sharp wave, spike wave,slow and sharp(spike)wave complex in 11patients.②rhythm of slow wave in 12patients.③rhythm of low voltage fast wave.in 15 patients.④universal low-voltage EEG in 8 patients.From the initial period of discharge,24 cases of unilateral discharge(14 in left,10 in right),2 cases of bilateral discharge were recorded,but 8 cases are not clear.The ictal period of EEG shows that:①high-amplitude sharp wave,spike wave,slow and sharp(spike) wave complex in 12 patients.②high-amplitude slow-wave in 11 patients.③rhythm of high voltage fast wave in 16 patients.From the ictal period of EEG,13 cases of unilateral discharge,7 cases of bilateral discharge were recorded and 14 cases are not clear.2:2.4.Location of EEG from interictal stage to ictal stage:31 cases(88.6%) can obtain location information from the EEG findings from interictal stage to ictal stage.Since ictal and interictal period did not meet in 4 cases,in order to determine the operated side,we must consider history,seizure type and imaging(MRI),which is suitable for the patient that can not be definite the seizure focus.2:2.5.Findings of intraoperative EEG:Cortical EEG epileptic discharges are found in all patients,which are almost high-amplitude sharp or spike waves.Epileptic discharge decreased significantly or even disappear in postoperative ECOG.Conclusions:The VEEG monitoring can significantly increase the detection rate of epileptic-form discharges,play an important role in the epilepsy diagnosis.Video EEG can provide an important basis for epilepsy preoperative localization.