EEG in the diagnosis, classification, and management of patients with epilepsy
EEG in the diagnosis, classification, and management of patients with epilepsy
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DOI：
10.1136/jnnp.2005.069245
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发表时间：
2005-06-01
影响因子：
11
通讯作者：
Smith, SJM
中科院分区：
文献类型：
--
作者：
Smith, SJM
脑电图（EEG）是由德国精神病学家汉斯·伯杰（Hans Berger）于1929年发现的。当吉布斯和他在波士顿的同事们在当时被称为癫痫小发作的癫痫中展示出每秒3次的棘波放电时，它在癫痫中的潜在应用迅速变得清晰。EEG与过去30年左右发展起来的各种各样的诊断技术相结合，在癫痫患者的诊断和治疗中继续发挥着核心作用，因为它是一种方便且相对廉价的方法来证明癫痫基础的异常皮层兴奋性的生理表现。由放置在头皮或大脑表面上的电极记录的电活动主要反映皮层更浅层中锥体神经元的顶端树突中的兴奋性和抑制性突触后电位的总和。相当大的皮层区域--大约几平方厘米--必须被同步激活，以产生足够的电位，从而使放置在头皮上的电极记录下变化。电活动沿着生理通路或通过细胞外空间中的容积传导的传播可能会对电活动源的位置产生误导性印象。脑电中记录的许多正常和异常皮层活动的皮层发生器在很大程度上仍然是未知的。常规头皮EEG中的空间采样是不完整的，因为大量的皮质，特别是在大脑半球的基底和近中区域，没有被标准电极放置覆盖。时间采样也是有限的，常规发作间期EEG记录的持续时间相对较短是癫痫患者在首次EEG研究中可能未显示发作间期癫痫样放电（IED）的原因之一。
The human electroencephalogram (EEG) was discovered by the German psychiatrist, Hans Berger, in 1929. Its potential applications in epilepsy rapidly became clear, when Gibbs and colleagues in Boston demonstrated 3 per second spike wave discharge in what was then termed petit mal epilepsy. EEG continues to play a central role in diagnosis and management of patients with seizure disorders—in conjunction with the now remarkable variety of other diagnostic techniques developed over the last 30 or so years—because it is a convenient and relatively inexpensive way to demonstrate the physiological manifestations of abnormal cortical excitability that underlie epilepsy.However, the EEG has a number of limitations. Electrical activity recorded by electrodes placed on the scalp or surface of the brain mostly reflects summation of excitatory and inhibitory postsynaptic potentials in apical dendrites of pyramidal neurons in the more superficial layers of the cortex. Quite large areas of cortex—in the order of a few square centimetres—have to be activated synchronously to generate enough potential for changes to be registered at electrodes placed on the scalp. Propagation of electrical activity along physiological pathways or through volume conduction in extracellular spaces may give a misleading impression as to location of the source of the electrical activity. Cortical generators of the many normal and abnormal cortical activities recorded in the EEG are still largely unknown. Spatial sampling in routine scalp EEG is incomplete, as significant amounts of cortex, particularly in basal and mesial areas of the hemispheres, are not covered by standard electrode placement. Temporal sampling is also limited, and the relatively short duration of routine interictal EEG recording is one reason why patients with epilepsy may not show interictal epileptiform discharge (IED) in the first EEG study.