摘要： 目的：探討頭皮腦電圖（electroencephalography，EEG）中高頻振蕩（high-frequency oscillations，HFOs）在癲癇性腦病伴睡眠中持續(xù)棘慢波（epileptic encephalopathy with continuous spike-and-wave during sleep，CSWS）患兒中的意義。方法：回顧性收集2006年1月至2016年12月在北京大學(xué)第一醫(yī)院就診的CSWS患兒21例，比較激素治療前HFOs陽性組和HFOs陰性組以及激素沖擊治療后發(fā)作有效組和無效組間患兒的性別、特征年齡、癲癇發(fā)作頻率及抗癲癇藥等電臨床資料，分析激素治療前后EEG中發(fā)作間期HFOs和棘波出現(xiàn)情況。結(jié)果：激素治療前，21例患兒中有12例（57%）EEG中記錄到HFOs，每人平均43.17/60 s。HFOs陽性組較HFOs陰性組激素治療前1個(gè)月負(fù)性肌陣攣/失張力/肌陣攣/不典型失神發(fā)作更頻繁（P=0.004）。激素治療前，共檢測到518個(gè)HFOs和22 592個(gè)棘波，441個(gè)（86%）HFOs復(fù)合于棘波，且HFOs和棘波的最大波幅呈正相關(guān)性（r=0.279，P<0.001）。激素治療后，HFOs（P=0.002）和棘波（P=0.006）均顯著減少，減少的百分比分別為91%（473/518）和39%（8 905/22 592）。13例（62%）激素治療后3個(gè)月內(nèi)無發(fā)作（有效組），另8例仍有發(fā)作或復(fù)發(fā)（無效組）。激素治療后，有效組HFOs出現(xiàn)率減少100%，棘波減少47%；治療無效組HFOs出現(xiàn)率減少79%，棘波增加14%。結(jié)論：HFOs可在一定程度上反映癲癇發(fā)作嚴(yán)重程度，且對激素治療較棘波更加敏感，與癲癇發(fā)作控制密切相關(guān)，可用于評估癲癇嚴(yán)重程度和治療療效。

關(guān)鍵詞: 高頻振蕩, 癲癇性腦病伴睡眠中持續(xù)棘慢波, 頭皮腦電圖, 時(shí)頻分析

Abstract: Objective： To investigate the clinical significance of high-frequency oscillations (HFOs) on scalp electroencephalography (EEG) in patients with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS). Methods: Twenty-one CSWS patients treated for epilepsy from January 2006 to December 2016 in Pediatric Department of Peking University First Hospital were enrolled into the study. Selected clinical variables including gender, age parameters, seizure frequencies and antiepileptic drugs were compared between （a）. HFO-positive group and HFO-negative group before methylprednisolone treatment and （b）. excellent seizure outcome group and not-excellent seizure outcome group after methylprednisolone treatment. Interictal HFOs and spikes in pre-and postmethylprednisolone scalp EEG were measured and analyzed. Results: Before methylprednisolone treatment, there were 12 of 21 (57%) CSWS patients had HFOs, with a mean value 43.17 per 60 s per patient. The 12 patients with HFOs tended to have more frequent epileptic negative myoclonus/atonic/myoclonus/atypical absences than those without HFOs in a month before methylprednisolone treatment. A total of 518 HFOs and 22 592 spikes were found in the pre-methylprednisolone EEG data of 21 patients, and 441 HFOs (86%) were associa-ted with spikes. The highest amplitudes of HFOs were significantly positively correlated with that of spikes (r=0.279, P<0.001). Rates reduced by methylprednisolone treatment were statistically significant for both HFOs (P=0.002) and spikes (P=0.006). The percentage of reduction was 91% (473/518) and 39% (8 905/22 592) for spikes and HFOs, respectively. The percentage of spike and HFOs changes was respectively 100% decrease and 47% decrease in the excellent seizure outcome group, and they were 79% decrease and 18% increase in the not-excellent seizure outcome group. Conclusion: Prevalence of HFOs might reflect some aspect of epileptic activity. HFOs were more sensitive to methylprednisolone treatment than spikes and had a good correlation with the prognosis of seizures, and HFOs could be applied to assess epilepsy severity and antiepileptic therapy.

Key words: High-frequency oscillations, Epileptic encephalopathy with continuous spike-and-wave during sleep, Scalp electroencephalography, Time-frequency analysis

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