Der Stellenwert des EEG in der Epilepsiediagnostik

M. Hoppe; R. Schulz

doi:10.1055/s-2003-812575

Klinische Neurophysiologie, Table of Contents

Klinische Neurophysiologie 2003; 34(4): 147-155
DOI: 10.1055/s-2003-812575

Originalia

Der Stellenwert des EEG in der Epilepsiediagnostik

Ranking of Surface EEG in Epilepsy DiagnosticsM. Hoppe¹ , R. Schulz¹

¹Abteilung für prächirurgische Intensiv-Diagnostik, Klinik Mara I, Epilepsie-Zentrum Bethel, Bielefeld

Abstract

Zusammenfassung

Seit seiner Entwicklung durch Berger Anfang des 20. Jahrhunderts kommt dem Oberflächen-EEG eine entscheidende Rolle bei der Diagnose und Therapie von Epilepsie zu. Bis heute ist es die einfachste, sicherste und kostengünstigste diagnostische Methode, die pathophysiologischen Basismechanismen des Gehirns zu registrieren, die den Epilepsien zugrunde liegen. Die Spezifizität und Sensitivität so genannter epilepsietypischer Potenziale wie Spitzen, scharfe Wellen und Spitze-Wellen-Komplexe liegen bei ungefähr 90 %, so dass ihr interiktales Auftreten im Oberflächen-EEG die Diagnose Epilepsie nahe legt, eine Ableitung während eines Ereignisses, die ein Anfallsmuster zeigt, dessen epileptische Natur sogar beweist. Maßnahmen wie Hyperventilation, intermittierende Fotostimulation, Schlafableitung, wiederholte oder längere Registrierungen erhöhen die Sensitivität, während von Seiten des Befunders die Kenntnis epilepsieähnlicher Potenziale - die so genannten benignen Varianten - die Spezifizität erhöht. Dies berücksichtigt, ist die Analyse epilepsietypischer Aktivität im Oberflächen-EEG hinsichtlich Lokalisation, Verhalten und Morphologie äußerst hilfreich bei der Diagnosesicherung Epilepsie und darüber hinaus bei der Bestimmung des Epilepsiesyndroms. In der prächirurgischen Diagnostik definiert es die irritative Region und das Anfallsursprungsareal, die beide unverzichtbar zur Bestimmung des epileptogenen Areals sind.

Abstract

Since its development in the early 20^th century by Berger, clinical EEG based on scalp electrodes has played a crucial role in the diagnosis and treatment of epilepsy. Until today EEG is the simplest, safest and most inexpensive diagnostic tool to directly register the basic pathophysiological cerebral mechanisms of epileptic disorders. Specificity and sensitivity of the interictal epileptiform potentials (IED) like spikes, sharp waves and spike-wave complexes is about 90 %, so that interictal occurrence of IED in surface EEG is strongly supportive of the diagnosis of epilepsy, and recording an ictal pattern proves the epileptic nature of an attack almost with certainty. Special procedures like hyperventilation, intermittent photic stimulation, prolonged or repeated recordings and sleep recordings can be performed to increase sensitivity and specificity. Also, certain patterns resembling epileptiform potentials - the so-called benign variants - should be familiar to the EEG reader. With these restraints, occurrence, shape, localization, and evolution of epileptiform activity in surface EEG is irreplaceable in the diagnosis of epilepsy and in the classification of the epileptic syndrome. In the preoperative diagnostic workup EEG defines the irritative region and ictal onset zone, both of which are indispensable to assess the epileptogenic region.

Key words

Surface EEG - epileptiform potentials - epilepsy - ictal patterns - benign variants

Full Text

References

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Dr. Matthias Hoppe

Epilepsie-Zentrum Bethel · Klinik Mara I

Maraweg 21

33617 Bielefeld

Email: hop@mara.de