23例以癫痫发作为首发症状的儿童抗NMDAR脑炎临床分析  

Clinical analysis of anti-NMDAR encephalitis in 23 children with epilepsy as the first symptom

作　　者：周杏[1] 刘志刚[1] ZHOU Xing;LIU Zhigang(Foshan Maternal and Child Health Hospital Affiliated to Southern Medical University,Guangdong Province,Foshan 528000,China;不详)

机构地区：[1]南方医科大学附属佛山妇幼保健院,广东佛山528000

出　　处：《现代医院》2020年第12期1854-1858,共5页Modern Hospitals

基　　金：广东省医学科研基金(B2017058);佛山市卫生和计生局医学科研课题立项(20180111)。

摘　　要：目的分析以癫痫发作为首发症状的儿童抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎的临床特征。方法收集2017年1月—2020年3月以癫痫发作为首发症状的23例抗NMDAR脑炎患儿的临床表现、实验室检查及治疗等资料,并随访其预后。结果 23例患儿中,男13例,女10例;起病年龄10个月~10岁9个月,中位年龄3岁7月。除癫痫为首发症状外,病程中常表现为运动障碍/不自主运动(20例、87.0%)。癫痫发作类型以全面性发作为主(11例、47.8%),形式为强直或强直-阵挛发作(18例、78.3%),2例存在惊厥性癫痫持续状态。脑电图显示局灶或弥漫性慢波为主的非特异性改变(19例、82.6%)。23例均予以静脉注射丙种球蛋白或/和激素治疗,19例予以抗癫痫药物治疗。多数预后良好,2例复发。结论以癫痫发作为首发症状的抗NMDAR脑炎与其余癫痫不一样,常有运动障碍等表现,脑电图显示慢波改变。早期予以免疫治疗和抗癫痫药物治疗预后良好。Objective To analyze the clinical characteristics of anti-N-methyl-D-aspartate receptor( NMDAR) in children with epilepsy as the first symptom. Methods The clinical manifestations,laboratory examination and treatment of 23 cases of anti-NMDAR encephalitis with epilepsy as the first symptom from January 2017 to March 2020 were collected,and the prognoses were followed up. Results Among the 23 cases,there were 13 males and 10 females. The onset age ranged from 10 months to 10 years and 9 months,and the median age was 3 years to 7 months. In addition to epilepsy as the first symptom,the course of the disease was often manifested as dyskinesia/involuntary movement( 20 cases,87. 0%). The main types of epileptic seizures was generalized seizure( 11 cases,47. 8%),the seizure form were tonic-clonic seizures and tonic-clonic seizures( 18 cases,78. 3%),and 2 cases presented convulsive epileptic status. The electroencephalogram showed nonspecific changes that were predominantly focal or diffuse slow waves( 19 cases,82. 6%). 23 patients received intravenous injection of gamma globulin or/and hormone therapy,and 19 patients received antiepileptic drugs( AEDs)treatment. The prognoses were good in most cases,with 2 cases of recurrence. Conclusion Epilepsy as the first symptom of anti-NMDAR encephalitis is not the same as other epilepsy,often has motor disorders and other manifestations,and electroencephalogram shows slow wave changes. Early immunotherapy and AEDs are associated with a good prognosis.

关 键 词：抗NMDAR脑炎 癫痫 临床特征 

分 类 号：R725[医药卫生—儿科] R741[医药卫生—临床医学]