Spike and Wave-Complexの臨床的意義

CLINICAL EVALUATION OF SPIKE AND WAVE-COMPLEX

まえがき

　臨床脳波における種々の異常発作波のうちでもspike（棘波）と高振幅の徐波との結合形，すなわちspike and wave-complex（棘徐波結合体—以下にはsp-w-cと略記する）は，主としててんかん患者においてしばしばその顕著なる波形を現わし，諸家によつて早くより注目されるところとなり，それに関する研究も数多く発表されている。

　これについては始めGibbs，Davis and Lennoxら^1）がてんかん患者の或る者において定型的な3/secのsp-w-cを記録し，かつこれとてんかん小発作（petit mal）との間に密接な関連の存在することをみとめたが，さらにGibbs，Gibbsand Lennoxら^2）はそれのみならずその異型として2〜2.5/secのsp-w-cの存することも見出し，これをpetit mal variantと名づけた。そして小発作欠神（petit mal absence）にともなう定型的な3/secのsp-w-cにおいては，その出現時以外の間歇時の脳波は殆んど正常の所見しか与えないが，これに反してpetit mal variantにおいてはその間歇時にもその脳波には徐波がみとめられ，かつそのような患者は臨床的には痙攣発作や筋搐搦発作をもつものが多いと述べた^3）。

　The correlation between electroencephalographic findings and clinical pictures was studied in 123 patients, chiefly epileptics and partially others, who showed the so-called "spike and wave-complexes (sp-w-c)" in their EEGs.

　It is only 22 epileptics which showed the sp-w-c in non-activated EEGs, and a large number of cases, by activation techiques. Hyperventilation procedure was effective in provocation of 3/sec. sp-w-c accompanying petit mal absence and sleep and cardiazol activations elicited 2~2.5/sec. sp-w-c in many cases, By those activation-methods there appeared sp-w-c in non-epileptic patients, too.

　The frequency of sp-w-c obtained by the author was as follows: the 2/sec. frequency was 23.6% and the 2.5/sec. was 25.2%, both parties amoung ca. 50% of the subjects; on the contrary the 3/sec., only 12.2%, The commencement with the spike of sp-w-c 82.9% and with the wave was 11.3%, and the cases with beginning of the wave was remarkable in 3/sec. sp-w-c accompanying petit mal absence. A majority of the sp-w-c discharge occurred in single or 2~3 appearances within 1~2 seconds of duration. The localization of classical 3/sec.