抗NMDA受体脑炎12例临床脑电图分析及文献回顾  

Analysis and literature review of clinical and EEG characteristics of anti-N-methyl-D-aspartate receptor encephalitis in 12 cases

作　　者：贾珊珊[1,2] 刘小红[1] 汪东[2] 赵斯钰[2] 

机构地区：[1]西安交通大学第一附属医院,陕西西安710061 [2]西安市儿童医院,陕西西安710003

出　　处：《中国妇幼健康研究》2016年第8期959-961,973,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨抗N-甲基-D-天冬氨酸(NMDA)受体脑炎临床、脑电图特征。方法回顾性分析12例西安市儿童医院收治的抗NMDA受体脑炎患者临床特点、脑电图特征并回顾文献资料。结果本研究12例患者中,1起病方式:精神行为异常8例,步态异常1例,惊厥3例;2临床表现:精神行为异常和性格改变12例,意识障碍9例,惊厥5例,不自主运动和肌张力障碍5例;3脑电图:脑电图正常3例,发作间期脑电图异常9例,9例均有背景活动减慢,其中弥漫性或局限于前后头部的δ波4例,多灶性放电4例,无一例见到δ刷;4预后:大多数患儿预后良好,有2例患儿存在语言减少、注意力不集中等轻微症状。结论抗NMDA受体脑炎在儿童不是一种少见疾病,临床表现多样,但肿瘤少见,脑电图表现多为非特异性慢波,少数可有多灶性放电或正常,早期诊断和积极免疫治疗可获得较好的预后。Objective To explore the clinical and electroencephalogram（ EEG） features of anti-N-methyl-D-aspartate（ anti-NMDA）receptor encephalitis. Methods The clinical features and EEG features of 12 children with anti-NMDA encephalitis were studied through a retrospective analysis and literature review was conducted. Results In the 12 cases of this study,there were 8 cases of psychiatric symptoms,1 case of gait disorder,and 3 cases of convulsion. There were 12 cases of psychiatric symptoms and character change,9 cases of disturbance of consciousness,5 cases of convulsion and 5 cases of involuntary movement and dystonia in clinical manifestation. Seen from EEG,there were 3 cases of normal EEG,9 cases of interictal abnormal EEG,and 9 cases of slowed background activities,among which there were 4 cases of diffuse or confined delta wave in the frontal lobe and occipital lobe,4 cases of multifocal discharge,and none of them had extreme delta brush in EEG. Most patients had good prognosis and 2 cases had mild sequela including reticence and inattention. Conclusion Anti-NMDA receptor encephalitis in children is not common,with a variety of clinical manifestations and absence of tumor. Most of the cases present with nonspecific slow wave in EEG,and a few may have multifocal discharge or present normal. Early diagnosis and effective immunological treatment are the keys to a better prognosis of the disease.

关 键 词：抗NMDA受体脑炎 临床表现 脑电图 预后 

分 类 号：R512.3[医药卫生—内科学] R725[医药卫生—临床医学]