一次发作事件中痉挛发作与部分性发作共存现象  

Epileptic spasms and partial seizures in a single ictal event

作　　者：杨志仙[1] 刘晓燕[1] 秦炯[1] 张月华[1] 包新华[1] 姜玉武[1] 常杏芝[1] 王爽[1] 熊辉[1] 吴晔[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《中国实用儿科杂志》2008年第7期493-495,共3页Chinese Journal of Practical Pediatrics

基　　金：卫生部临床学科重点项目基金(20010912)资助

摘　　要：目的探讨婴儿痉挛(IS)患儿一次发作事件中部分性发作(PS)和痉挛发作(ES)共存的现象(PS-ES)。方法2002年2月至2006年4月北京大学第一医院收治的IS患儿,对存在PS-ES现象的14例进行分析。结果14例中男9例,女5例。癫起病年龄为生后1d至2岁,监测到PS-ES现象的时间为生后1个月至2.9岁。PS-ES发作可为PS后紧跟ES,ES后紧跟PS,成串ES中混有PS。起病的惊厥类型分别有PS、ES及PS和ES同时起病,与PS-ES的组合方式无特定的相关性。PS-ES现象中的PS发作多起源于中央、顶区。半数以上患儿有病因和(或)影像学异常。经治疗的11例中5例短期有明显的临床和EEG改善,但仅3例得到了较长时间的控制。随访11例患儿发现智力运动发育均落后。结论一次发作性事件中PS和ES可以不同的顺序组合出现,与起病时首发惊厥类型无特定的相关性。具有PS-ES现象的IS患儿可存在多种病因,且多数患儿治疗反应差及预后不良。Objective To investigate the phenomenon of epileptic spasms （ES） associated with partial seizures （PS） in a single ictal event （ PS-ES phenomenon） in infantile spasms （IS） patients. Methods During the period of 2002 to 2006 ,we analyzed retrospectively 14 IS patients,who had PS-ES phenomenon in First Hospital of Peking University. Resuits Of the 14 patients,9 were male, and 5 were female. The onset age of epilepsy was from 1 day to 2 years. Age at onset of the phenomenon ranged between one month and 2. 9 years. We identified three groups with different seizure patterns regarding the temporal association of ES and PS ： PS followed by ES ; ES followed by PS ; PS appearing during a cluster of ESs without interrupting the cluster. The onset seizure types included PS, ES, and ES with PS. There was no special relationship between different groups of ES-PS phenomenon and onset seizure types. The ictal discharges of PS in PS-ES phenomenon most involved central and parietal regions. The abnormality of cause of disease and/or iconography was seen in half of patients. The clinical and EEG improved shortly after treatment in 5 of 11 patients, however, the seizures were controlled by antiepileptic drugs for a long time only in 3 patients. During follow-up, we found that psychomotor outcomes were poor in all patients. Conclusion The temporal association of ES and PS in a single event has different combinations and has no correlation with the onset of seizure types. Patients of IS with PS-ES phenomenon had many etiologies and most of them might have poor response to antiepileptic drugs and poor prognosis.

关 键 词：痉挛 婴儿 脑电描记术 癫 

分 类 号：R72[医药卫生—儿科]