儿童额叶癫癎的临床及脑电图特征

目的总结儿童额叶癫痫（FLE）的临床和脑电图（EEG）特征及预后,加强对于FLE的认识。方法收集本科2000～2006年治疗40例FLE患儿,进行临床资料回顾性分析。病例均行24hEEG和影像学检查。内容包括FLE病例的家族史、发作类型、先兆、伴随症状,EEG和影像学表现及治疗效果。比较各发作类型、EEG表现和药物疗效差异。结果癫痫发作表现为阵挛24例,强直4例,精神行为3例,侧转、失张力、呕吐各2例,视觉、感觉异常、头痛各1例。头颅影像学检查发现异常9例。有明确脑损伤史,病毒性脑炎病史各1例。均有发作期额叶样放电或者慢波表现。随访1～6年,其中用药后发作消失35例,3例发作减少,2例无效。一线抗癫痫药物效果比较无统计学差异。结论FLE发作表现为频繁、短暂和夜间多发。认识特征性的发作表现,可为FLE诊断提供线索,动态EEG检查对于FLE是必须检查手段;抗癫痫药物首选使用卡马西平。

Clinical and Electroencephalography Features of Childhood Frontal Lobe Epilepsy

Objective To explore the clinical and electroencephalography features of children's frontal lobe epilepsy(FLE)and improve the diagnosis and therapy.Methods Medical records were reviewed and neuropsychological evaluations of patients with FLE diagnosed from 2000 to 2006.Children were examined by 24 h EEG and imaging examinations.Their charts for family medical history,seizure,aura,simultaneous phenomenon and anti-epilepic drug therapeutic effects were reviewed.Results Seizures were clonus in 24 cases,tonic in 4 cases,adversive,atonic,vomit in 2 cases,respectively,paresthesia,cephalic,visul,sensory in 1 case,Imaging finding were in 9 of 40.All the 40 cases were bought into 1 to 6 years' follow-up.Long-term control was achieved in 35 of 40.Partial control was achieved in 3 of 40.The left 2 cases had no response to the anti-epileptic drugs.Conclusions The common features of FLE included high seizure frequency,short duration and nocturnal preponderance.There is high positive rate of active EEG in detecting epileptic discharges,and active EEG shoud be necessary.Carbamazepine is recommended to be the first choice to FLE.