癫痫患者合并震颤的特征及相关因素分析  

The features and associated factors of tremor in patients with epilepsy

作　　者：郭文静 魏雅荣[1] 唐兴华[1] 李琳[1] 刘振国[1] Guo Wenjing;Wei Yarong;Tang Xinghua;Li Lin;Liu Zhenguo(Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院神经内科,200092

出　　处：《中华神经科杂志》2020年第12期996-1002,共7页Chinese Journal of Neurology

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2017YFC1310300);国家自然科学基金青年基金项目(81601127)。

摘　　要：目的探究癫痫患者合并震颤的临床及电生理特征,分析震颤发生的相关影响因素。方法收集2018年9月至2019年9月就诊于上海交通大学医学院附属新华医院神经内科的癫痫患者80例,根据临床评估分为震颤组及无震颤组,均行临床震颤量表评定及肌电图震颤分析检查。并分析癫痫患者发生震颤的相关因素。结果临床评估结果表明80例患者中27.5%(22/80)的癫痫患者主诉或体检发现有震颤,均表现为上肢姿势性震颤,7.5%(6/80)的患者同时伴有静止性震颤。肌电图震颤分析结果表明,51例(63.8%,51/80)有上肢震颤,是临床评估发生率的2.3倍。其中42例(82.3%,42/51)有上肢姿势性震颤,震颤峰频率为(7.2±4.1)Hz,肌电爆发模式以同步爆发为主;32例(62.7%,32/51)有上肢静止性震颤,震颤峰频率为(5.3±2.2)Hz,肌电爆发模式以交替爆发为主。多因素分析结果显示服药种类多以及长时间服用丙戊酸与震颤的发生具有显著相关性。结论癫痫患者出现的震颤以上肢姿势性震颤为主,肌电图震颤分析能够早期发现癫痫患者出现的震颤,服药种类多及长时间服用丙戊酸与震颤的发生相关。Objective To investigate the clinical and electrophysiological characteristics of tremor in patients with epilepsy,and explore the related factors affecting the occurrence of tremor.Methods A cross-sectional survey was conducted to collect 80 patients with epilepsy in the Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2018 to September 2019.Patients were divided into tremor group and non-tremor group according to clinical evaluation.All patients with epilepsy were evaluated by the Clinical Rating Scale for Tremor and were examined by electromyography(EMG).Results There were 22(27.5%,22/80)patients who were found with tremor by self-reported complaint and(or)physical examination by clinicians,mainly manifested as postural tremor in the upper limbs,and 7.5%(6/80)patients also showed resting tremor.The EMG examination revealed that 51 patients(63.8%,51/80)had tremor in the upper limbs.The incidence was 2.3 times as much as clinical evaluation.Among them,42 patients(82.3%,42/51)manifested postural tremor in upper limbs,32 patients(62.7%,32/51)manifested resting tremor.The peak frequency of postural tremor was(7.2±4.1)Hz,and synchronous burst pattern was mainly showed.The peak frequency of resting tremor was(5.3±2.2)Hz,and alternating burst pattern was mainly showed.Multivariate analysis showed that large number of medications and long duration of taking valproate acid were significantly related to the occurrence of tremor in patients with epilepsy.Conclusions Tremor is mainly manifested as postural tremor in the upper limbs in patients with epilepsy.The EMG is a more sensitive and objective examination,which can detect tremor that was not yet noticed.Large number of medications and long duration of taking valproate acid might be the mainly associated factors for occurrence of tremor in patients with epilepsy.

关 键 词：癫痫 震颤 肌电图 丙戊酸 

分 类 号：R742.1[医药卫生—神经病学与精神病学]