青少年肌阵挛癫痫患者的临床特征、影像学及诊治过程分析  

Analysis of clinical characteristics,neuroimaging,diagnosis and treatment process of inpatients with juvenile myoclonic epilepsy

作　　者：凡振玉[1] 刘亚青[1] 党小利[1] 宋文珺[1] 石蓓[1] 武治军 王文杰 白文红 李军强 王天成[1] FAN Zhenyu;LIU Yaqing;DANG Xiaoli;SONG Wenjun;SHI Bei;WU Zhijun;WANG Wenjie;BAI Wenhong;LI Junqiang;WANG Tiancheng(Epilepsy Centre,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院癫痫中心,兰州730030

出　　处：《癫痫杂志》2021年第4期309-313,共5页Journal of Epilepsy

基　　金：甘肃省重点研发计划-社会发展类(21YF1FA171)。

摘　　要：目的探讨青少年肌阵挛癫痫(Juvenile myoclonic epilepsy,JME)住院患者的一般临床特征、影像学、就诊过程及治疗情况。方法回顾性分析2016年1月—2020年8月在兰州大学第二医院癫痫中心住院的83例JME患者,总结其临床特征、发作类型、诱发因素、头部核磁共振成像(MRI)和脑电图(EEG)检查结果、首诊医院、就诊原因及药物治疗情况。结果83例患者中男43例,女40例,平均年龄(18±5.6)岁,21例患者有癫痫家族史或热惊厥史,平均发病年龄(11.5±3.0)岁,早于无家族史和热惊厥史者,差异具有统计学意义(P<0.05)。14例患者头部核磁共振成像(MRI)检查结果异常,主要包括海马硬化和局部小囊肿。62.7%的患者首发症状为肌阵挛发作,其次是强直阵挛性发作,睡眠不足是最常见的诱发因素,而强直阵挛性发作是JME患者最常见的就诊原因,占78.3%。80.7%的患者首诊医院选择当地基层医院,治疗上存在抗癫痫发作药物(ASMs)使用不规范现象,且ASMs治疗后的癫痫控制无发作率为6%,低于省级医院,差异具有统计学意义(P<0.05)。88%的JME住院患者通过单药治疗能够有效控制发作,其中,丙戊酸是最常用的单药和联合治疗药物。新型口服ASMs—拉莫三嗪和左乙拉西坦片相对多用于女性患者。结论癫痫家族史和热惊厥史可能与JME患者的发病年龄早相关,少部分JME患者可以有影像学异常发现,包括海马硬化和局部小囊肿。强直阵挛性发作是JME患者的主要就诊原因,发病后多首诊于当地医院,但当地医院给予ASMs治疗后的癫痫控制无发作率较低,故对基层医师开展癫痫相关知识的培训有助于临床JME的诊断和提高其控制率。Objective To explore the clinical characteristics,neuroimaging,diagnosis and treatment process of inpatients with juvenile myoclonic epilepsy.Methods 83 inpatients with JME in the Epilepsy Center of Lanzhou University Second Hospital from January 2016 to August 2020 were analyzed retrospectively.Their clinical features,seizure types,inducing factors,MRI and EEG,first consultation hospital,reason for visit and drug treatment were summarized.Results Among the 83 patients,there were 43 males and 40 females,with an average age of(18±5.6)years.21 patients had family history of epilepsy or history of febrile convulsion.the average age of onset was 11.5 years old,which was earlier than those without family history and history of febrile convulsion(P<0.05).The results of cranial nuclear magnetic resonance examination were abnormal in 14 patients,including hippocampal sclerosis and local small cysts.The first symptom of 62.7%JME patients is myoclonic seizures,followed by tonic-clonic seizures,sleep deprivation was the most common inducing factor,and tonic-clonic seizures was the most common cause of treatment in JME patients,accounting for 78.3%.80.7%of patients choose local primary hospitals for their first consultation,and there was a non-standard use of ASMs in treatment,and the seizure free rate of epilepsy after ASMs treatment was 6%,which was lower than that in provincial hospitals(P<0.05).88%of JME inpatients can effectively control their seizures through monotherapy,among which valproic acid is the most commonly used monotherapy and combination therapy.The new oral ASMs lamotrigine and levetiracetam tablets were mostly used in female patients.Conclusion A family history of epilepsy and history of febrile convulsion may be associated with an earlier age of onset in patients with JME.Neuroimaging abnormalities can be found in a small number of patients with JME,including hippocampal sclerosis and local small cysts.Tonic-clonic seizures is the main treatment cause of JME patients,and most of them are first diagnosed

关 键 词：青少年肌阵挛癫痫 临床特征 药物治疗 影像学 首诊医院 

分 类 号：R742.1[医药卫生—神经病学与精神病学]