抗GABA(B)R脑炎临床、脑电图及随访研究  

Clinical, electroencephalogram, and follow-up observations of patients with anti-GABA(B)receptor encephalitis

作　　者：陈萍[1] 刘之荣[1] 杜芳[1] 冯国栋[1] 王津存[1] 吴中亮[1] 赵钢[1] CHEN Ping;LIU Zhi-rong;DU Fang;FENG Guo-dong;WANG Jin-cun;WU Zhong-liang;ZHAO Gang(Department of Neurology , the Xijing Hospital, Fourth Military Medical University, Shanxi 710032, China)

机构地区：[1]第四军医大学西京医院神经内科,陕西710032

出　　处：《脑与神经疾病杂志》2016年第10期599-602,共4页Journal of Brain and Nervous Diseases

基　　金：国家自然科学基金项目(81371334)

摘　　要：目的 分析抗GABA（B）R脑炎临床，影像学及脑电图（EEG）特征。方法 5例血清和脑脊液（CSF）抗GABA（B）R抗体阳性的抗GABA（B）R脑炎，分析CSF白细胞数、头颅磁共振（MRI）、24h长程视频脑电图（VEEG）和预后特点。结果 5例抗GABA（B）R脑炎中，精神行为异常2例，意识障碍2例，CSF白细胞数增高4例，癫痫发作5例，其中癫痫持续状态4例（80%）。24hVEEG监测3例各导可见多量阵发性长程持续5~30s、4~6Hzθ节律，并前额、额、前颞可见尖波或复合性慢波。未见异常2例。头颅MRI异常1例，累及海马、额叶皮质。呼吸衰竭1例，行气管插管，未用呼吸机辅助呼吸。1例合并血和CSF抗Hu抗体阳性并发肺癌。随访半年死亡3例（60%），完全正常2例（40%）。结论 抗GABA（B）R脑炎是以癫痫发作为特点的疾病，本组5例患者均早期出现严重的癫痫发作。预后与癫痫的严重程度和是否合并肿瘤有关。Objective To analysis the clinical presentation, electroencephalogram and follow-up of antiGABA(B) receptor encephalitis. Method Five patients were confirmed to have serum and cerebrospinal fluid(CSF)antibodies to the GABA(B) receptor.To analysis the charactor of white blood cells in CSF,head MRI,24 hour longtermvideo electroencephalogram(VEEG) and prognosis. Results In the five patients with anti GABA(B) receptorencephalitis,two patients showed psychiatric disorder,two patients showed disturbance of consciousness.White bloodcells in CSF of four patients with anti GABA(B) receptor encephalitis were higher than that of normal person.. Fivepatients of seizure including four status epileptics.By 24hVEEG ,three patients showed multiple paroxysmal long range4-6Hz theta rhythm lasting 5-30s accompanied with sharp wave or complex slow wave.Two case was normal VEEG.One patient was abnormal signals in MRI involving the hippocampus and frontal cortex. One patient with respiratoryfailure was treated with tracheal intubation, without breathing machine. Anti-Hu antibody positive concurrent lung cancer in one case with blood and cerebrospinal.With half a year follow-up, three cases died(60%), two cases werecompletely recovered(40%). Conclusion Anti GABA(B) receptor encephalitis is a disease characterized byseizures.In this group, five patients had severe epileptic seizures in early stage. The prognosis is related to the severityof epilepsy and whether it is associated with the tumor.

关 键 词：抗GABA(B)R脑炎 癫痫持续状态 临床症状 

分 类 号：R512.3[医药卫生—内科学]