伴中央颞区棘波的儿童自限性癫痫及其共病注意力缺陷多动障碍的临床研究  

A clinical study on children with self-limited epilepsy with centrotemporal spikes and attention-deficit hyperactivity disorder comorbidity

作　　者：王梦莹 李慧敏 耿雨梅 周青 王嫚[1] 康慧聪[1] Wang Mengying;Li Huimin;Geng Yumei;Zhou Qing;Wang Man;Kang Huicong(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《中华神经医学杂志》2024年第6期552-559,共8页Chinese Journal of Neuromedicine

基　　金：国家重点研发计划"常见多发病防治研究"重点专项(2022YFC2503800);中国抗癫痫协会癫痫科研基金-UCB基金(2020020A);湖北省自然科学基金(2022CFB279);湖北省自然科学基金青年项目(2022CFB714)。

摘　　要：目的总结伴中央颞区棘波的儿童自限性癫痫(SeLECTS)的临床及脑电图特征,并初步探索其共病注意力缺陷多动障碍(ADHD)的危险因素。方法收集并分析自2020年7月至2024年3月于华中科技大学同济医学院附属同济医院神经内科诊治的122例SeLECTS患儿的人口学及病史资料、癫痫发作特征、脑电图资料及治疗信息,并采用SNAP-Ⅳ量表评估患儿是否共病ADHD,据此分为共病ADHD组(n=64)与未共病ADHD组(n=58),分析2组患儿间临床及脑电图特征(放电部位、放电侧别、双侧放电同步性、放电时期、棘波频率、特殊波形等)的差异,以探索共病ADHD的危险因素。结果(1)临床特征:122例患儿中男性70例(57.38%),女性52例(42.62%);发病年龄为(7.50±1.98)岁,范围为3~12岁;72.95%(89/122)的仅于入睡后1 h内发作,9.84%(12/122)的仅于清晨觉醒前1~2 h发作,9.84%(12/122)的于入睡后及清晨觉醒前均有发作;单次发作持续时间为(116.60±89.68)s,范围为10~600 s。(2)脑电图特征:122例患儿的脑电图背景活动均无明显异常;93.20%(96/103)的放电部位位于中央颞区,6.80%(7/103)的位于中央颞区及以外脑区(包括额区、前头部、双侧枕中线及双侧大脑半球);包含整夜脑电图记录的69例患儿的棘波频率为35.00(20.67,55.00)次/min,范围为0.33~86.33次/min。(3)治疗信息:120例接受药物治疗的患儿中87例(72.50%)接受单药治疗,包括丙戊酸30例(34.48%)、奥卡西平21例(24.14%)、拉考沙胺17例(19.54%)、左乙拉西坦17例(19.54%)、吡仑帕奈1例(1.15%)、拉莫三嗪1例(1.15%);33例(27.50%)接受2种或2种以上药物联合治疗。(4)共病ADHD的危险因素:与未共病ADHD组比较,共病ADHD组患儿的发病年龄更小,单次发作持续时间更长,入睡后和觉醒前均有癫痫发作比例更高,脑电图中棘波频率更高,差异均有统计学意义(P<0.05)。结论SeLECTS患儿多于3~12岁起病,在入睡后1 h内或觉醒前1~2 h出现癫痫发作,脑电图背Objective To summarize the clinical and EEG characteristics of children with self-limited epilepsy with centrotemporal spikes(SeLECTS),and explore the risk factors for comorbid attention-deficit hyperactivity disorder(ADHD).Methods Demographic and medical history data,seizure characteristics,EEG data,and treatment information of 122 children with SeLECTS admitted to Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2020 to March 2024 were collected.Based on Swanson,Nolan and Pelham-IV Rating Scale(SNAP-IV)results,these patients were divided into comorbid ADHD group(n=64)and non-ADHD group(n=58);the clinical data and EEG characteristics(location and lateralization of discharges,synchronicity of bilateral discharges,period of discharges,spike wave frequency and special waveforms)of the patients between the 2 groups were compared to analyze the risk factors for comorbid ADHD.Results (1)In 122 SeLECTS children,70(57.38%)were males and 52(42.62%)were females;onset age was(7.50±1.98)years(3-12 years);72.95%(89/122)patients had seizures only within 1 h after falling asleep,9.84%(12/122)had seizures only 1-2 h before awakening in the morning,9.84%(12/122)had seizures both after falling asleep and before awakening in the morning;duration of a single episode was(116.60±89.68)seconds(10-600 seconds).(2)Background activity in EEG showed no obvious abnormalities;the discharges were located in the central temporal region in 93.20%(96/103)patients and in the central temporal region and other brain regions(including frontal region,anterior head,bilateral occipital midline and bilateral cerebral hemispheres)in 6.80%(7/103)patients;among 69 patients whose overnight EEG recording was obtained,the spike frequency was 35.00(20.67,55.00)times/min(0.33-86.33 times/min).(3)Among 120 patients who accepted drug treatment,87(72.50%)received monotherapy,including valproic acid(n=30,34.48%),oxcarbazepine(n=21,24.14%),lacosamide(n=17,19.54%),levetiracetam(n=17,19.54%),pera

关 键 词：癫痫 伴中央颞区棘波的儿童自限性癫痫 Rolandic区 注意力缺陷多动障碍 脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R749.94[医药卫生—临床医学]