1. 발작간간질형방전 (Interictal epileptiform discharges) 2. 주기성일측성간질형방전 (Periodic lateralized epileptiform discharges) Interictal epileptiform discharge IEDs

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1 KISEP Reviews 생물정신의학 Vol. 8, No. 2, December 2001 간질의평가와진단 - 발작간뇌파소견을중심으로 - 박건우 * Interictal EEG in Diagnosis and Assessment of Epilepsy Kun-Woo Park, M.D., Ph.D. * ABSTRACT T KEY WORDS 뇌파검사의유용성 Department of Neuroloy, Korea University, College of Medicine, Seoul, Korea 교신저자 흔히발견되는발작간이상뇌파의유형

2 1. 발작간간질형방전 (Interictal epileptiform discharges) 2. 주기성일측성간질형방전 (Periodic lateralized epileptiform discharges) Interictal epileptiform discharge IEDs Fig. 1. Criteria of interictal dischargesieds. IEDs 의양성예측치 (Positive Predictive Value) - 3. 광범위한주기성예파 (Generalized periodic sharp waves) 4. 국소성및광범성서파 (Focal or generalized slow waves) 5. 비특이성돌발파 (Nonspecific paroxysmal pattern) - 1. 간질환자에서 IEDs는얼마나자주관찰되는가?

3 2. 간질이아닌환자에서 IEDs의관찰정도는? 3. 요약하면 IEDs 를유발시키는방법은? 1. 수면및수면박탈 (Sleep deprivation) 2. 과호흡 (Hyperventilation) 3. 광자극 (Photic stimuli) - 4. 검사를여러번한다. 5. 전극을추가한다

4 Table 1. International classification of seizures 1., Partialfocal, local Seizures 1 Simple partial seizures 1 with motor symptoms 2 with somatosensory or special sensory symptoms 3 with autonomic symptoms and signs 4 with psychic symptoms 2 Complex partial seizures 1 Simple partial onset followed by impairement of consciousness 2 with impairment of consciouness at onset 3 Partial seizures evolving to secondarily generalized seizures, tonic-clonic, tonic, or clonic 1 Simple partial seizures evolving to generalized seizures 2 Complex partial seizures evolving to generalized seizures 3 Simple partial seizures evolving to complex partial seizures to generalized seizures 2. Generalized Seizuresconvulsive and non-convulsive 1 (Absence seizures1 Typical 2 Atypical 2 Myoclonic seizures 3 Clonic seizures 4 Tonic seizures 5 Tonic-clonic seizures 6 Atonic sizures 3. Unclassified epileptic seizures Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 간질증후군의진단에있어발작간뇌파의역할 - Table 2. Classification of epilepsies, epileptic syndromes and related seizure disorders 1. Localization-relatedfocal, local, partial epilepsies and syndromes 1. 1 Idiopathicwith age-related onset Benign childhood epilepsy with centro-temporal spikes Childhood epilepsy with occipital paroxysms Primary reading epilepsy 1. 2 Symptomatic Chronic progressive epilepsia partialis continua of childhoodkojewnikow syndrome Seizures characterized by specific modes of precipitation 1. 3 Cryptogenic 2. Generalized epilepsies and syndromes 2. 1 Idiopathicwith age-related onset - Listed in order of age Benign neonatal familial convulsions Benign neonatal convulsions Benign myoclonic epilepsy in infancy Childhood absence epilepsy Juvenile absence epilepsy Juvenile myoclonic epilepsy Epilepsy with generalized tonic-clinic seizures on awakening Other generalized idiopathic epilepsies not defined above Epilepsies with seizures characterized by specific modes of precipitatione.g. photosensitive epilepsy 2. 2 Crytogenic and/or symptomaticin order of age West syndromeinfantile spasms Lennox-Gastaut syndromes Epilepsy with myoclonic-astatic seizures Epilepsy with myoclonic absences 2. 3 Symptomatic Non-specific aetiology Early myoclonic encephalopathy Early infantile epileptic encephalopathy with suppression-bursts Other symptomatic generalized epilepsies not defined above Specific syndromes 3. Epilepsies and syndromes undetermined whether focal or generalized 3. 1 With both generalized and focal seizures Neonatal seizures Severe myoclonic epilepsy in infancy Epilepsy with continuous spike-waves during slow wave sleep Acquired epileptic aphasialandau-kleffner syndrome Other undetermined epilepsies not defined above 3. 2 Without unequivocal generalized or focal features 4. Special syndromes 4. 1 Situation-related seizures Febrile convulsions Seizures occurring only in the context metabolic or toxic events 4. 2 Isolated seizures or isolated status epilepticus Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia

5 Table 3. Characteristic EEG findings in specific epileptic syndromes Differential diagnosis EEG findings 1 Childhood absence epilepsy Atypical absence of Lennox-Gastaut syndrome Temporal lobe epilepsy 3Hz spike-wave Slow generalized spike-wave activity Temporal sike or sharp waves 2 Benign childhood epilepsy with Centrotemporal focus of spikes centro-temporal spikes Temporal lobe epilepsy Temporal sike or sharp waves 간질환자에서인지기능의장애를보일때뇌파검사의역할 처음경련을보인환자에서뇌파검사의역할 항경련제중단시뇌파검사의역할 - 추천웹싸이트 중심단어 : 참고문헌 Berg AT, Shinnar S(1991):The risk of seizure recurrence following a first unprovoked seizure. A quantitative review. Neurology 41: Cavazzuti GB, Capella L, Nalin A(1980):Longtitudinal study of epilepriform EEG patterns in normal children. Epilepsia 21:43-55 Ellingston RJ, Willken K, Bennet DR(1984):Efficacy of sleep deprivation as an activation procedure in epilepsy patients. J Clin Neurophysiol 1: Goodin DS, Sminoff MJ(1984):Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1: Homan RW, Jones MC, Rawat S(1988):Anterior temporal electrodes in complex partial seizures. Electroencephalogr clin Neurophysiol 70: Kellaway P(1980):The incidence, significance and natural history of spike foci in children. In:Henry CE, ed:current Clinical Neurophysiology:update on EEG and Evoked Potentials. Elsevier/North Holland, pp Pedley TA, Bazil CW, Morrell MJ(1987):Epilepsy In Merrit's Textbook of Neurology, Rowland LP, 10th eds. Lippincott Williams & Wilkins, Philadelphia, pp Salinksy M, Kanter R, Dasheiff RM(1987):Effectiveness if multiple EEGs in supporting the diagnosis if epilepsy:an operation curne. Epilepsia 28: Sato SS, Dreifuss FE, Penry JK, Kirby DD, Palesch Y(1983):Longterm follow-up of absence seizures. Neurology 36: Shinnar S, Vining EPG, Mellits ED, DSouza BJ, Holden K, Baumgardner RA, Freeman JM(1985):Discounting antiepileptic medication in children with epilepsy after two years without seizures. A prospective study. N Engl J Med 313: Sperling MR, Mendius JR, Engel J(1986):Mesial temporal spikes:

6 a simultaneous comparison of spenoidial, nasopharngeal, and ear electrodes. Epilepsia 27:81-86 Treiman DM. Walton NY, Wickboldt C, Degiorgio C(1987):Predictable sequence of EEG changes during generalized stasus epilepticus in man and three experimental models of status epilepticus in the rat. Neurology 37: Van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerk AC(1998): Value of the electroencephalogram in adult patients with untreated idiolpathic first seizures. Arch Neurol 49: Walsh JM, Brenner RP(1987):Periodic lateralized epileptiform dis- charges-long term outocme in adult. Epilepsia 28: Walczac TS, Jayakar P(1997):Interictal EEG In Epilepsy:A Comprehensive Textbook, Engel J and Pedley TA eds, Lippincott-Raven Publisher, Philadelphia. pp Wolf P, Gooses R(1986):Relation of photosensitivity to epileptic syndromes. J Neurol Neurosurg Psychiatry 49: Young GB, Goodenough P, Jacono V, Schieven JR(1987):Periodic lateralized epileptiform discharges(pleds):electrographic and clilnical features. Am J EEG Technol 28:

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<30302EC2F7B7CA2E687770> 대한임상신경생리학회지 9(2):63~68,2007 ISSN 1229-6414 Controversies in Clinical Neurophysiology 간질치료에서뇌파의임상적유용성에관한논란 : 긍정적관점에서 가톨릭대학교의과대학신경과학교실 손영민 김영인 Young-Min Shon, M.D., Yeong In Kim, M.D. Department of Neurology,