门诊视频脑电图在癫痫样放电检测中的最优检查时长被引量：1

The optimal examination duration for the detection of epileptiform discharge in outpatient video-electroencephalography

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摘要目的通过计算门诊视频脑电图不同检查时长的癫痫样放电检出率,确定最优检查时长。方法回顾性分析2020年10月至2021年11月在首都医科大学宣武医院门诊就诊、检查时长为4 h、有癫痫样放电的患者,计算不同检查时长(0~0.5 h、0~1 h、0~2 h、0~3 h和0~4 h,分别记为A组、B组、C组、D组和E组)癫痫样放电检出率;计数每例患者0~4 h每1小时内(记为H1组、H2组、H3组、H4组)的癫痫样放电量,计算每小时标化癫痫样放电量;计数每例患者清醒期、思睡期、睡眠Ⅰ期、Ⅱ期和Ⅲ期的癫痫样放电量,计算各期标化癫痫样放电量;计数每例患者0~4 h每小时内睡眠时长,分别记为H1′组、H2′组、H3′组、H4′组。采用配对资料的Wilcoxon符号秩检验两两比较H1、H2、H3和H4组每小时标化癫痫样放电量,清醒期、思睡期、睡眠Ⅰ期、Ⅱ期和Ⅲ期的醒睡各期标化癫痫样放电量,以及H1′组、H2′组、H3′组和H4′组的睡眠时长的差异,以确定最优检查时长。结果共入组80例患者,年龄[M(Q_(1),Q_(3))]31(21,39)(范围5~68)岁;其中男38例,女42例。A组癫痫样放电检出率42.5%(34/180),B组81.3%(65/80),C、D和E组均为100%(80/80)。H1组标化癫痫样放电量[M(Q_(1),Q_(3))]为24.8%(7.8%,44.2%),H2组41.5%(25.9%,63.3%),H3组15.1%(1.3%,27.8%),H4组1.3%(0,14.5%);H2组标化癫痫样放电量高于H1组、H3组和H4组(均P<0.05)。清醒期标化癫痫样放电量[M(Q_(1),Q_(3))]为9.6%(0,28.2%),思睡期3.6%(0,16.9%),睡眠Ⅰ期3.3%(0,11.8%),睡眠Ⅱ期47.3%(21.9%,72.5%),睡眠Ⅲ期0(0,11.5%);睡眠Ⅱ期标化癫痫样放电量高于清醒期、思睡期、睡眠Ⅰ期和Ⅲ期(均P<0.05)。H1′组睡眠时长[M(Q_(1),Q_(3))]13.6(2.5,23.6)min,H2′组睡眠时长35.8(16.5,54.2)min,H3′组睡眠时长14.5(0,34.7)min,H4′组睡眠时长0(0,14.6)min,H2′组睡眠时长高于H1′组、H3′组和H4′组(均P<0.05)。结论本研究推荐门诊2 h视频脑电图,既保证癫痫样放电的检出率,又有利于患者配合,优化医疗资源配置。 Objective To determine the optimal examination duration by evaluating the detection rate of epileptiform discharges(EDs)with different examination duration of video-electroencephalography(EEG)in outpatients.Methods Patients with EDs who underwent 4-hour EEG examination from Xuanwu Hospital,Capital Medical University from October 2020 to November 2021 were retrospectively enrolled,and the detection rates of EDs were calculated with examination duration of 0-0.5 h,0-1 h,0-2 h,0-3 h,and 0-4 h(group A,B,C,D and E),respectively.For each patient,EDs in each hour(group H1,group H2,group H3,group H4)were counted,and the standardized amount of EDs was calculated.For each patient,EDs in wakefulness,drowsiness,non-rapid eye movement-Ⅰ(NREM-Ⅰ),NREM-Ⅱand NREM-Ⅲwere counted,and the standardized amount of EDs in each state was calculated.Meanwhile,the sleep duration per hour of each patient was also counted(group H1′,group H2′,group H3′,group H4′).The Wilcoxon paired test was used for intergroup comparison to determine the optimal examination duration.Results A total of 80 patients were enrolled,and aged[M(Q_(1),Q_(3))]31(21,39)years(range:5-68 years).There were 38 males and 42 females.The detection rate of EDs was 42.5%(34/80)in group A,81.3%(65/80)in group B,and 100.0%(80/80)in group C,group D and group E,respectively.The standardized amount of EDs of H1,H2,H3 and H4 was 24.8%(7.8%,44.2%),41.5%(25.9%,63.3%),15.1%(1.3%,27.8%)and 1.3%(0,14.5%),respectively.The standardized amount of EDs of H2 was significantly higher than that of H1,H3 and H4(all P<0.05).The standardized amount of EDs in wakefulness,drowsiness,NREM-Ⅰ,NREM-Ⅱand NREM-Ⅲwere 9.6%(0,28.2%),3.6%(0,16.9%),3.3%(0,11.8%),47.3%(21.9%,72.5%)and 0(0,11.5%),respectively.The standardized amount of EDs in NREM-Ⅱwas significantly higher than that in wakefulness,drowsiness,NREM-Ⅰand NREM-Ⅲ(all P<0.05).The sleep duration in the group of the H1′,H2′,H3′and H4′was 13.6(2.5,23.6),35.8(16.5,54.2),14.5(0,34.7)and 0(0,14.6)minutes,respectively.The sleep duration in the group of the H2′group was significantly longer than that in the group of H1′,H3′and H4′(all P<0.05).Conclusion The study recommends 2 hours video-EEG in outpatients,which not only ensures the detection rate of EDs,but also facilitates patient cooperation and optimizes the allocation of medical resources.

作者张跃馨陈润泽杨昆李京屈凯旋曾敏灵王英王黎林一聪王玉平 Zhang Yuexin;Chen Runze;Yang Kun;Li Jing;Qu Kaixuan;Zeng Minling;Wang Ying;Wang Li;Lin Yicong;Wang Yuping(Department of Neurology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;Department of Pediatrics,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;Xuanwu Hospital of Capital Medical University,National Center for Neurological Disorders,Beijing 100053,China;Department of Electrophysiology,the Fifth Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450000,China;Department of Neurology,the Third Clinical Medical College of the Three Gorges University,Yichang 443002,China;Department of Neurology,Xunxian People′s Hospital of Henan Province,Hebi 456250,China)