抗N-甲基-D-天冬氨酸受体脑炎及其伴随痫性发作的临床特点  

Clinical features of anti-N-methyl-D-aspartate receptor encephalitis and the concomitant seizure

作　　者：吴凌超 胡崇宇[2] 龙莉莉[1] 龙小艳[1] 李静[1] 刘卫平[1] 毕方方[1] 肖波[1] WU Lingchao;HU Chongyu;LONG Lili;LONG Xiaoyan;LI Jing;LIU Weiping;BI Fangfang;XIAO Bo(Department of Neurology,Xiangya Hospital,Central South University,Changsha 410008;Department of Neurology,Hunan Provincial People's Hospital,Changsha 410005,China)

机构地区：[1]中南大学湘雅医院神经内科,长沙410008 [2]湖南省人民医院神经内科,长沙410005

出　　处：《中南大学学报（医学版）》2019年第5期544-548,共5页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81671300);中南大学湘雅医院临床科研基金(2016L08);湘雅医院-北大未名临床与康复研究基金(xywm2015I32)~~

摘　　要：目的:探讨抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎的临床特点及其伴随痫性发作的特征。方法:回顾性分析中南大学湘雅医院2016年1月至2018年7月确诊为抗NMDAR脑炎的20例患者资料,包括临床特点、痫性发作特点、辅助检查、治疗方案等,并对出院患者进行半年随访。结果:抗NMDAR脑炎患者首发症状主要为痫性发作及精神行为异常。抗NMDAR脑炎患者伴随痫性发作类型主要为全面性发作,脑电图多为广泛慢波。与无痫性发作组比较,有痫性发作组MRI示颞叶病变和出现意识障碍的频率更高(P<0.05)。经规范治疗出院后半年随访,20例患者改良Rankin量表(modified Rankin Scale, mRS)评分得到明显改善,未再出现痫性发作。结论:发病期间出现意识障碍、颞叶有病灶的抗NMDAR脑炎患者,需注意有痫性发作的可能。如有痫性发作,应及时使用抗癫痫药物及免疫治疗,并去除病因。经规范治疗后,患者预后大多较好。Objective:To investigate the clinical features,auxiliary examination and characteristics for anti-Nmethyl-D-aspartate receptor(anti-NMDAR)encephalitis and its concomitant seizure.Methods:A total of 20 patients diagnosed as anti-NMDAR encephalitis were enrolled from January 2016 to September 2018 in Xiangya Hospital.The data including the clinical features,auxiliary examination,characteristics of seizure,treatment and prognosis were collected.The discharged patients were followed up for half a year.Results:The initial symptom in patients with anti-NMDAR encephalitis were mainly psychiatricsymptom and seizure.Most of the EEG result were diffused slow waves.The mainly type of seizure in patients with anti-NMDAR encephalitis showed generalized tonic-clonic seizure.Patients occurred consciousness during the onset of the disease.MRI showed that patients with temporal lobe were more inclined to occur seizure than patients with anti-NMDAR encephalitis(P<0.05).After standardized treatment,20 patients showed a significant improvement in modified Rankin Scale(mRS)scores and the seizure was under control within half a year.Conclusion:Patients with temporal lobe affected in MRI should pay attention to the possibility of seizure occurrence.Anti-epileptic drugs and immunotherapy should be used promptly in patient with seizure.After standardized treatment,the prognosis of patients will be mostly good.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 临床特点 痫性发作 

分 类 号：R742.9[医药卫生—神经病学与精神病学]