儿童非惊厥性持续状态的脑电图五例  

The distinct characteristic of video electroencephalogram of non-convulsive status epilepticus in children

作　　者：赵绚 贾宇 张礼萍[1] 戚小红[1] Zhao Xuan;Jia Yu;Zhang Liping;Qi Xiaohong(Department of Pediatrics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院儿科,北京100053 [2]首都医科大学宣武医院神经内科,北京100053

出　　处：《脑与神经疾病杂志》2023年第2期67-70,共4页Journal of Brain and Nervous Diseases

基　　金：北京市医院管理中心儿科学科协同发展中心儿科专项一般项目(XTYB201810)。

摘　　要：目的总结分析儿童非惊厥性癫痫持续状态(NCSE)多种脑电图(EEG)异常放电模式。方法2016年9月至2020年9月首都医科大学宣武医院儿科收治的5例NCSE患儿,分析患儿的发作诱因、临床表现、EEG异常及治疗反应等情况。结果报道的5例患儿,男童2例,女童3例。发病年龄1~12岁(中位值4岁2月)。5例均有反应迟钝,不同程度的智力倒退,其中例5有性格改变。NCSE诱因分析发现5例中感染引起惊厥持续状态后出现NCSE1例(例4),抗癫痫药物调整过程中发作1例(例2),癫痫发作控制不佳1例(例5),突然停用所有抗癫痫药物1例(例3),诱因不明1例(例1)。发作期EEG特征多样,包括反复长时间的发作期放电,局部起始伴扩散和演变,左右反复交替出现(例1);全导高波幅慢波及右侧局灶性(Rolandic区)持续放电(例2);全导弥漫性高幅2.5~3Hz左右慢波、棘慢波长程发放(例3);全导持续周期性高幅慢波、尖慢波呈发放(例4)。双侧前头部(额极、额、中央、顶为主导联)5Hz高幅持续性慢波(例5)。所有患儿发作时静脉推注地西泮,临床症状及EEG均有不同程度的改善。结论NCSE的临床表现和EEG异常复杂多样,相似的临床症状可能会有不同模式的EEG异常表现。提高对NCSE症状学及EEG的认识并及时给予终止发作治疗是有效改善NCSE不良预后的关键。Objective To summarize the video electroencephalogram(VEEG)of child patients with Non-Convulsive Status Epilepticus(NCSE)in children.Methods The clinical information of 5 child patients with NCSE admitted to the Department of Pediatrics,Xuanwu Hospital,Capital Medical University from september 2016 to september 2020 were collected and analyzed.Results Of the 5 cases reported,2 were boys and 3 were girls.The onset age ranged from 1 to 12 years.All 5 patients developed slow response and mental regression,and 1 patient had personality disorders.The factors of NCSE onset included infection in 1 patient,adjustment of antiepileptic drugs in 1 paitent,secondary to convulsive status epilepticus in 1 patient,stop all the anti-seizure medications(ASM)suddenly in 1 patient and unknown etiology in 1 patients.The characteristics of VEEG were varied,including prolonged epileptic discharges with focal initiation accompanied by diffusion,and repeated alternation from left to right(case 1);a large amount of slow wave of high amplitude in all regions and epileptiform discharges in the right Rolandic region(case 2);generalized diffuse slow activity of high amplitude with 2.5-3Hz(case 3);periodic slow wave and spike and ware complex of high amplitude(case 4);generalized diffuse slow activity in bilateral anterior regions(case 5).Diazepam was injected intravenously during the attack,and the clinical symptoms and EEG of all patients were improved to varying degrees.Conclusion The clinical manifestations and EEG abnormalities of NCSE are complex and varied,and similar clinical symptoms may have different patterns of EEG abnormalities.The key to improve the prognosis of NCSE is to improve the recognition of symptoms and electroencephalography of NCSE and to give timely treatment.

关 键 词：非惊厥性癫痫持续状态 反应迟钝 视频脑电图 癫痫样异常放电 苯二氮䓬类 

分 类 号：R742.1[医药卫生—神经病学与精神病学]