减药对儿童癫痫术前评估长程脑电图监测的影响  

The effect of medication withdraw on long-term electroencephalogram monitoring in children who need preoperative assessment for refractory epilepsy

作　　者：王文[1] 王爽[1,2] 于国静 刘通 刘晓燕[1,2] 蔡立新[1] WANG Wen;WANG Shuang;YU Guojing;LIU Tong;LIU Xiaoyan;CAI Lixin(Pediatric Epilepsy Center,Peking University First Hospital,No.1,Xi’anmen Street,Xicheng District,Beijing 100034,China;Department of Pediatrics,Peking University First Hospital,No.1,Xi’anmen Street,Xicheng District,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿童癫痫中心,北京100034 [2]北京大学第一医院儿科,北京100034

出　　处：《癫痫杂志》2021年第2期93-97,共5页Journal of Epilepsy

摘　　要：目的分析减药对难治性癫痫患儿术前评估进行长程脑电图监测的影响。方法回顾性分析2018年8月—2019年12月期间北京大学第一医院儿童癫痫中心需术前评估的难治性癫痫患儿,进行术前长程脑电图监测的资料。监测时长:①已监测到3次临床发作,或②监测时间满10天。按既定方案减停抗癫痫药物(AEDs)。结果本研究中共576例患儿需要癫痫术前评估的发作期脑电图(EEG),年龄范围10月龄~17岁,平均年龄(5.9±6.3)岁,中位年龄4.4岁,其中75例(75/576,13.0%)需要减药才能获取发作期EEG。75例患儿中男38例,女37例。年龄范围15月龄~17岁,平均年龄(8.3±4.2)岁,中位年龄7.0岁。分析65例遵照既定减药方案减药患儿的EEG及临床资料:总监测时长为44.1 h(约2天)~241.8 h(约10天),中位数:118.9 h(约5天)。减药前发作间期脑电图EEG表现:局灶性发作间期痫样放电(Iinterictal epileptiform discharge,IED)39例(39/65,60%),局灶及广泛性IED 2例(2/65,3.1%),多灶性IED 20例(20/65,30.7%),多灶及广泛性IED 2例(2/65,3.1%),减药前无IED为2例(2/65,3.1%)。减药后IED无变化18例(18/65,27.7%);减药后IED有变化共47例:加重46例(46/65,70.8%),减少的仅1例。在46例IED加重的患儿中,原有IED增多41例(41/46,89.1%);出现广泛性IED 5例(5/46,10.9%)。46例IED加重的患儿87.3%出现在减药后3天内。减药后56例(86.2%,56/65)出现发作,均监测到惯常发作,其中80.4%在减药3天内出现发作。8例(14.3%)出现继发双侧强直阵挛发作(Bilateral tonic-clonic seizure,BTCS),其中仅1例惯常发作中未见BTCS。56例患儿中,94.6%(53/56)减2种AEDs即可出现发作。结论①本组难治性癫痫患儿中13.0%需要减停AEDs获得发作期EEG;②其中绝大部分患儿(86.2%)可通过减药获得发作期EEG,减药后的IED和发作期EEG对致痫灶定位仍很有帮助;③绝大多数患儿减停2种AEDs或减停AEDs 3天内即可获得发作期EEG;④新出现的发作泛化极为少见。Purpose To analyze the effect of medication withdraw(MW)on long-term electroencephalogram(EEG)monitoring in children who need preoperative assessment for refractory epilepsy.Methods Retrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019.Monitoring duration:①at least three habitual seizures were detected,or②the monitoring duration were as long as 10 days.MW protocol was according to the established plan.Results A total of 576 children(median age 4.4 years)required presurgical ictal EEGs,and 75(75/576,13.0%)needed MW for ictal EEGs.Among the 75 cases,38 were male and 37 were female.The age range was from 15 months to 17 years(median age:7.0 years).EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed.The total monitoring duration range was from 44.1 h(about 2 days)to 241.8 h(about 10 days)(median:118.9 h(about 5 days)).Interictal EEG features before MW were including focal interictal epileptiform discharge(IED)in 39 cases(39/65,60%),focal and generalized IED in 2 cases(2/65,3.1%),multifocal IED in 20 cases(20/65,30.7%),multifocal and generalized IED in 2 cases(2/65,3.1%),and no IED in 2 cases(2/65,3.1%).After MW,18 cases(18/65,27.7%)had no change in IED and the other 47 cases had changes of IED after MW.And IEDs in 46 cases(46/65,70.8%)were aggravated,and IED was decreased in 1 case.The pattern of aggravated IED was original IED increasement,in 41 cases(41/46,89.1%),and 5 cases(5/46,10.9%)had generalized IED which was not detected before MW.Of the 46 patients with IED exacerbations,87.3%appeared within 3 days after MW.Habitual seizures were detected in 56 cases(86.2%,56/65)after MW,and within 3 days of MW in 80.4%cases.Eight patients(14.3%)had secondary bilateral-tonic seizure(BTCS),of which only 1 patient had no BTCS in his habitual seizures.In 56 cases,94.6%(53/56)had

关 键 词：癫痫 抗癫痫药物 长程脑电图监测 术前评估 儿童 

分 类 号：R726.5[医药卫生—儿科]