Ictal pattern of EEG and muscular activation in symptomatic infantile spasms: A videopolygraphic and computer analysis
Ictal pattern of EEG and muscular activation in symptomatic infantile spasms: A videopolygraphic and computer analysis
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DOI：
10.1046/j.1528-1157.2002.15302.x
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发表时间：
2002-12-01
期刊：
影响因子：
5.6
通讯作者：
Tassinari, CA
中科院分区：
文献类型：
--
作者：
Bisulli, F;Volpi, L;Tassinari, CA
目的：研究以症状性婴儿痉挛症 (IS) 为特征的发作性肌肉现象及其与发作性脑电图的关系。方法：四名患有严重脑病、神经功能障碍和与不同发育不良病变相关的难治性 IS 的儿童，接受视频测谎记录，收集多个颅骨和四肢肌肉的表面肌电图 (EMG) 活动，以评估 IS 的肌肉募集模式、持续时间和左右不对称性。所获得的数据被存储起来，以便通过计算机测谎系统进行离线分析。结果：痉挛的特征是复杂的肌肉激活模式。所有患者都缺乏恒定的或轴尾传播模式。每次痉挛中不同肌肉的肌电图活动发作之间的间隔很长：小于或等于100-200毫秒。两名患有半球皮质发育不良和胼胝体发育不全的患者患有不对称和异步痉挛，其中受影响半球对侧肌肉的肌电图发作持续先于同侧肌肉的肌电图发作。脑电图活动的反向平均揭示了与发育不良病变同一侧的高振幅脑电图复合波，在对侧肌肉活动开始之前或之后。在另外两名患有弥漫性皮质发育不良的患者中，没有脑电图瞬变与肌电图活动发作相关。结论：尽管同一患者的痉挛之间存在临床相似性，但我们的数据证明了这些运动现象的复杂性和异质性。我们的发现不能像皮质肌阵挛或惊吓反射等其他运动现象一样简单地用皮质或网状发生器来解释。
Purpose: To investigate ictal muscular phenomena characterizing symptomatic infantile spasms (ISs) and their relation to ictal EEG.Methods: Four children with severe encephalopathy, neurologic impairment, and refractory ISs related to different dysplastic lesions, underwent videopolygraphic recordings collecting surface electromyogram (EMG) activity from several cranial and limb muscles to evaluate the pattern of muscular recruitment, duration, and side-to-side asymmetry of ISs. Acquired data were stored for off-line analysis by a computerized polygraphic system.Results: Spasms were characterized by a complex pattern of muscular activation. A constant or rostrocaudal propagation pattern was lacking in all patients. Intervals between the onset of EMG activity in different muscles in each spasm were very long: less than or equal to 100-200 ms. Two patients, with hemispheric cortical dysplasia and agenesis of the corpus callosum, had asymmetric and asynchronous spasms in which the EMG onset of the muscles contralateral to the affected hemisphere constantly anticipated that of the ipsilateral ones. Backaveraging of EEG activity disclosed a high-amplitude EEG complex on the same side as the dysplastic lesion, preceding or succeeding the contralateral muscle activity onset. In the other two patients with diffuse cortical dysplasia, no EEG transient was related to EMG activity onset.Conclusions: Despite clinical similarity between spasms in the same patient, our data demonstrate the complexity and heterogeneity of these motor phenomena. Our findings cannot be explained simply in terms of cortical or reticular generators like other motor phenomena such as cortical myoclonus or startle reflex.