儿童抗N-甲基-D-天冬氨酸受体脑炎继发癫痫的相关影响因素分析  

Related Influencing Factors Analysis of Epilepsy Secondary to Anti-N-methyl-D-aspartate Receptor Encephalitis in Children

作　　者：齐乐 孙丹 QI Le;SUN Dan(School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;Department of Neurology,Wuhan Children′s Hospital,Wuhan 430016,Hubei,China)

机构地区：[1]江汉大学医学部,湖北武汉430056 [2]武汉儿童医院神经内科,湖北武汉430016

出　　处：《江汉大学学报（自然科学版）》2024年第6期87-96,共10页Journal of Jianghan University：Natural Science Edition

基　　金：湖北省科技计划立项项目(2022DCC020)。

摘　　要：目的目前抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎患儿恢复期继发癫痫的风险低,相关研究较少,大部分临床医生对其认识不足。对继发癫痫和非继发癫痫的抗NMDAR脑炎患儿进行对比研究,以提高临床医生对抗NMDAR脑炎及其继发癫痫的临床特征及相关影响因素的认识。方法回顾性分析2015年1月至2022年1月就诊于武汉儿童医院神经内科的50例确诊抗NMDAR脑炎患儿的临床资料,根据最后随访时患儿是否继发癫痫分为脑炎后癫痫组(PE组)和脑炎后非继发癫痫组(NO-PE组),采用泊松回归分析进行统计。结果脑炎后癫痫发生率为8%(4/50)。50例患儿男女比为0.61∶1,继发癫痫患儿男女比是1∶3。抗NMDAR脑炎临床症状表现多样,最常见临床症状之一的癫痫发作占86%(43/50),其中以癫痫发作为起病的占64%(32/50)。继发癫痫患儿中有75%(3/4)也是以癫痫发作作为首发症状,同时更容易遗留运动障碍(50%(2/4))和学习能力下降(75%(3/4))。治疗上,大部分脑炎患儿给予免疫治疗,急性期有74%(37/50)给予抗癫痫药物治疗。PE组头颅影像学示皮质下受累(75%(3/4)比13%(6/46))、累及基底节区(50%(2/4)比0(0/46))及脑电图提示存在δ刷(50%(2/4)比8.7%(4/46))与NO-PE组比较差异均有统计学意义(P<0.05)。结论抗NMDAR脑炎患儿临床症状表现多样,继发癫痫发生率低,进展为脑炎后癫痫,若及时添加抗癫痫药物可控制发作;头颅影像学示皮质下受累、基底节区受累及脑电图提示存在δ刷的患儿更易继发癫痫。Objective The current low risk of secondary epilepsy in children recovering from N-methyl-D-aspartate receptor(NMDAR)resistant encephalitis is poorly studied and under-recognized by most clinicians.A comparative study of children with anti-NMDAR encephalitis secondary to epilepsy and non-secondary to epilepsy was conducted to improve clinicians′understanding of the clinical features and associated factors influencing anti-NMDAR encephalitis and its secondary epilepsy.Methods A retrospective analysis was conducted on the clinical data of 50 children with confirmed anti-NMDAR encephalitis who visited the neurology department of Wuhan Children′s Hospital from January 2015 to January 2022.Based on whether the children had secondary epilepsy at the final follow-up,they were divided into the post-encephalitis epilepsy group(PE group)and the postencephalitis non-secondary epilepsy group(NO-PE group).Poisson regression analysis was used for statistics.Results The incidence of post-encephalitis epilepsy was 8%(4/50).The male-to-female ratio of 50 children was 0.61∶1.The male-to-female ratio of children with secondary epilepsy was 1∶3.The clinical manifestations of anti-NMDAR encephalitis were diverse,with epilepsy being one of the most common clinical symptoms,accounting for 86%(43/50),of which 64%(32/50)were initiated by epilepsy.Among children with secondary epilepsy,75%(3/4)also had seizures as the first symptom and were more likely to have motor disorders left(50%(2/4))and decreased learning ability left(75%(3/4)).In terms of treatment,most children with encephalitis received immunotherapy,and 74%(37/50)of them were treated with antiepileptic drugs in the acute phase.The head imaging showed there was a statistically significant difference(P<0.05)between the PE group and the NO-PE group in subcortical involvement(75%(3/4)vs.13%(6/46)),involvement of the basal ganglia area(50%(2/4)vs.0%(0/46)),and electroencephalography showing the presenceδbrush(50%(2/4))vs.(8.7%(4/46)).Conclusion The clinical symptoms of chil

关 键 词：自身免疫性脑炎 脑炎后癫痫 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R512.3[医药卫生—临床医学]