儿童癫痫持续状态的临床特点、治疗及预后分析

目的探讨儿童癫痫持续状态(SE)的临床特点、治疗策略及预后。方法回顾性分析2015年1月至2019年10月空军军医大学唐都医院神经外科收治的36例儿童SE患者的临床资料。采用抗癫痫药物、麻醉药物等控制SE后,根据患儿的具体情况进一步行手术(24例)或药物治疗(12例)癫痫。观察SE的控制情况、癫痫的预后及相关并发症。结果36例患儿的年龄均≤14岁,其中≤3岁者22例;症状性SE 29例,特发性SE 7例;惊厥性SE 32例,非惊厥性SE 4例;可控性SE 25例,难治性SE(RSE)8例,超难治性SE(SRSE)3例;有诱发因素者29例;影像学异常者24例;脑电图显示大脑异常放电者35例,放电抑制者1例。36例患儿中,28例采用抗癫痫药物治疗后SE完全控制,8例给予了麻醉药物。33例SE完全控制,1例部分有效(为RSE患儿),2例无效者均死亡(均为SRSE患儿);控制时间为10 min至72 h(中位时间为40 min)。13例出现SE治疗的相关并发症。共33例患儿获得随访,随访时间为(2.5±1.4)年(1.0~5.5年)。手术治疗的24例患儿中,5例发生手术相关并发症;术后随访EngleⅠ级者20例,Ⅱ级者4例。采用药物治疗的9例患儿,发作频率降低≥50%者6例,发作频率降低<50%者3例。结论低龄尤其是≤3岁者SE高发,大部分患儿为症状性且有明显诱因,影像学异常者多见,脑电图均异常;抗癫痫药物和麻醉药可控制大部分SE,但RSE和SRSE患儿的疗效差;手术治疗对预防症状性SE及改善其预后效果较好。

Clinical characteristics,treatment and prognosis of status epilepticus in children

Objective To explore the clinical characteristics,treatment strategies and prognosis of status epilepticus(SE)in children.Methods The clinical data of 36 children with SE who were admitted to Department of Neurosurgery,Tangdu Hospital of Air Force Medical University from January 2015 to October 2019 were retrospectively analyzed.After controlling SE with antiepileptic drugs,anesthetics and so on,further surgery or medication was performed to treat epilepsy according to the specific situation of the child.The control of SE,outcome of epilepsy and related complications were documented.Results The ages of 36 children were all≤14 years old,among whom 22 children were≤3 years old.In this series,29 patients had secondary epilepsy and 7 patients had primary epilepsy.There were 32 patients of CSE(convulsive status epilepticus)and 4 patients of NCSE(non-convulsive status epilepticus).There were 25 patients of ASE(aborted status epilepticus),7 patients of RSE(refractory status epilepticus)and 3 patients of SRSE(super-refractory status epilepticus).There were 29 patients with predisposing factors,24 patients with abnormal imaging,35 patients with abnormal EEG,and 1 patient with EEG suppression.Of all 36 children,SE was completely controlled after antiepileptic therapy in 28 patients,and anesthesia was administered in 8 patients.Thirty-three patients of SE were completely controlled,1 patient with RSE was partially effective,and 2 patients died(both with SRSE).The interval to control ranged from 10 min to 72 h(median:40 min).Complications related to SE treatment occurred in 13 patients.Thirty-three children were followed up for 2.5±1.4 years(1.0-5.5 years).Among the 24 patients undergoing surgery,surgery-related complications occurred in 5 patients.Postoperative follow-up indicated Engel I in 20 patients and Engel II in 4 patients.Among the 9 patients treated with drug therapy,a reduction of seizure frequency by≥50%was reported in 6 and that by≤50%was observed in 3.Conclusions Young children,particularly those≤3 years old,have a high incidence of SE.Most of the children have secondary epilepsy and obvious causes,abnormal imaging and electroencephalography.Antiepileptic drugs and anesthetics can control most of SE,but the outcomes of children with RSE or SRSE are poor.Early surgical treatment is effective in prevention of secondary SE and improvement of outcome.