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 - 233 -
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? - - 234 -
2. 간질이아닌환자에서 IEDs의관찰정도는? 3. 요약하면 IEDs 를유발시키는방법은? 1. 수면및수면박탈 (Sleep deprivation) 2. 과호흡 (Hyperventilation) 3. 광자극 (Photic stimuli) - 4. 검사를여러번한다. 5. 전극을추가한다. - - 235 -
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 198930389399 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 2. 3. 1 Non-specific aetiology Early myoclonic encephalopathy Early infantile epileptic encephalopathy with suppression-bursts Other symptomatic generalized epilepsies not defined above 2. 3. 2 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 198930389399-236 -
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: 965-972 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 1:83-101 Goodin DS, Sminoff MJ(1984):Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1:837-838 Homan RW, Jones MC, Rawat S(1988):Anterior temporal electrodes in complex partial seizures. Electroencephalogr clin Neurophysiol 70:105-109 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, pp151-175 Pedley TA, Bazil CW, Morrell MJ(1987):Epilepsy In Merrit's Textbook of Neurology, Rowland LP, 10th eds. Lippincott Williams & Wilkins, Philadelphia, pp813-834 Salinksy M, Kanter R, Dasheiff RM(1987):Effectiveness if multiple EEGs in supporting the diagnosis if epilepsy:an operation curne. Epilepsia 28:331-334 Sato SS, Dreifuss FE, Penry JK, Kirby DD, Palesch Y(1983):Longterm follow-up of absence seizures. Neurology 36:1590-1595 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 313:976-980 Sperling MR, Mendius JR, Engel J(1986):Mesial temporal spikes: - 237 -
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 37:244-245 Van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerk AC(1998): Value of the electroencephalogram in adult patients with untreated idiolpathic first seizures. Arch Neurol 49:231-237 Walsh JM, Brenner RP(1987):Periodic lateralized epileptiform dis- charges-long term outocme in adult. Epilepsia 28:533-536 Walczac TS, Jayakar P(1997):Interictal EEG In Epilepsy:A Comprehensive Textbook, Engel J and Pedley TA eds, Lippincott-Raven Publisher, Philadelphia. pp831-848 Wolf P, Gooses R(1986):Relation of photosensitivity to epileptic syndromes. J Neurol Neurosurg Psychiatry 49:1386-1391 Young GB, Goodenough P, Jacono V, Schieven JR(1987):Periodic lateralized epileptiform discharges(pleds):electrographic and clilnical features. Am J EEG Technol 28:1-13 - 238 -