流行性乙型脑炎后癫癎的临床及神经心理研究  

Clinical and neuro-psychological analysis of epilepsy patients caused by Japanese encephalitis

作　　者：丁玎[1] 洪震[1] 周玢[1] 王蓓[1] 黄茂盛[1] 曾军[1] 郭起浩[1] 

机构地区：[1]复旦大学神经病学研究所,上海200040

出　　处：《上海医学》2004年第1期36-38,共3页Shanghai Medical Journal

摘　　要：目的　探讨乙型脑炎后癫的发生率、临床表现及其对患者大脑功能的影响。方法　对 1973～1994年患乙型脑炎的 85例患者进行随访。结合病史进行神经系统体格检查、简易智力状态检查 (MMSE)、智力(WAIS或WISC)和记忆力 (WMS)测定及日常生活功能量表 (ADL)评定。结果　 10例患者均有不同类型的癫发作 ,9例为全身强直 阵挛样发作 (GTCS) ,1例为失神发作。另有 2例在随访前因癫发作 (GTCS)死亡。合计发现 12例 ( 14 .1% )乙型脑炎后癫病例 ,其中 9例在出院后 1～ 17年出现癫发作 ,迟发癫的发生率为10 .6 % ( 9/ 85例 ) ,由生存分析计算得出病后 17年的累积发生率为 16 .1%。在接受检查的 10例癫患者中 ,有2例MMSE得分为 0分 ;分别有 6例和 8例存在智力缺陷和记忆力低下 ;4例ADL评分异常。结论　儿童期乙型脑炎病毒感染后所致的后遗症中 ,癫是发生率较高且预后较差的一种 ,预防和控制乙型脑炎在降低癫发病方面能起到一定的作用。Objective To investigate the morbidity, clinical symptoms, and brain functions of epilepsy patients caused by Japanese encephalitis. Methods 85 patients suffered from Japanese encephalitis during 1973 to 1994 were followed and evaluated using neurological examination, mini mental state examination (MMSE), intelligence and memory measurements, and activity of daily life (ADL).Results 10 patients were found to have epilepsy of diverse types, including 9 cases of generalized tonic clonic seizures (GTCS) and 1 case of absence seizures. Another 2 cases died of GTCS before evaluation. Totally 12 cases (14.4%) were evaluated to have epilepsy, among whom 9 had seizure for 1～17 years after discharge. The morbidity of late occurrence of epilepsy was 10.6%. The cumulative morbidity of epilepsy occurred within 17 years after discharge was 16.1% as calculated by survival analysis. Among 10 epilepsy patients evaluated, 2, 6 and 8 cases were confirmed to have abnormal MMSE, mental retardation, and memory defect, respectively. 4 were considered to have disability because of the abnormal ADL scores. Conclusions Epilepsy with higher morbidity and worse prognosis is one of the sequelae caused by Japanese encephalitis virus infection during childhood. Prevention by vaccine and control of the disease should have some impact on the decrease of morbidity.

关 键 词：流行性乙型脑炎 癫痫 神经心理学 并发症 发生率 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]