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目的 研究视频脑电联合多导同步表面肌电(VEEG+ SEMG)对辅助诊断癫痫不同运动性发作类型及鉴别发作性疾病的应用价值.方法 选择天津医科大学总医院神经内科癫痫门诊2009年1月至2012年12月以反复性运动性发作的拟诊癫痫患者116例进行VEEG+ SEMG检测,根据其临床发作特点设计肌电安装部位,给予常规诱发及特殊诱发和刺激(肢体运动及姿势诱发、触摸、声响、扣击肌腱、双臂伸直试验等),监测患者发作情况.结果 VEEG+ SEMG共监测到发作567次/68例,包括癫痫发作443次/41例,其中癫痫性肌阵挛(EMS) 229次/22例、强直发作95次/8例、痉挛发作118次/10例、失张力发作1次/1例,它们的SEMG平均时程分别是:(0.16 ±0.04)s、(2.9±2.4)s、(1.4±0.8)s、2s,其发作期EEG及SEMG表现各不相同;非癫痫性发作包括非癫痫性肌阵挛(NEMS) 43次/2例、发作性运动诱发性运动障碍(PKD)发作81次/25例.癫痫性运动发作主要与NEMS及PKD鉴别.结论 VEEG+ SEMG是癫痫发作类型诊断及鉴别发作性疾病的可靠工具.

Objective To explore the value of video-electroencephalography plus surface electromyography (VEEG + SEMG) in providing theoretic rationales for clinical diagnosis of different motor seizure types and differentiating the application value of paroxysmal diseases.Methods A total of 116 suspected and repetitive motion epileptics underwent VEEG + SEMG from 2009 to 2012.According to their clinical features,different muscles were selected to record electromyography (EMG) under different activations and stimulations (bodily movement and posture activation,touching,sound stimulus,tapping tendons and arms straight test,etc) and monitor their seizure states.Results Among 68 patients,567 attacks were recorded,including 443 epileptic seizures in 41 patients (229 epileptic mycological seizures in 22 patients,95 tonic seizures in 8,118 epileptic spasms in 10 and 1 atonic seizure in 1).The average durations of different epileptic motor seizures were (0.16 ± 0.04),(2.9 ± 2.4),(1.4 ± 0.8) and 2 s respectively.Their features of ictal EEG and SEMG varied.Non-epileptic seizures were recorded,including 43 non-epileptic myoclonus (NEMS) in 2 patients 81 PKD in 25.The primary differential diagnoses of epileptic motor seizures were NEMS and paroxysmal kinesigenic dyskinesia (PKD).Conclusion VEEG + SEMG is a reliable tool for diagnosing different types of epileptic seizures and differentiating among paroxysmal diseases.