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目的探讨儿童非惊厥性癫痫持续状态(NCSE)的临床表现、脑电图(EEG)特征、治疗及预后,提高诊疗水平。方法对2005年1月至2011年4月山东大学附属省立医院小儿神经科病房收治的12例NCSE患儿临床及EEG资料进行分析,并随访治疗疗效及预后。结果 12例中男8例、女4例,平均起病年龄(6.22±3.72)岁,发作持续时间平均为35h,失神癫痫持续状态(ASE)3例,精神运动性癫痫持续状态(PSE)9例。其中意识障碍12例,语言表达障碍9例,精神行为异常8例,复杂自动症5例,幻觉及饮食增多、烦渴各2例,自主神经症状1例。发作期EEG背景节律活动均变慢,3例为全导持续性棘慢综合波、慢波发放;9例为周期性或持续性限局性癫痫性放电,以θ波或δ波为主5例,以棘(尖)慢波为主4例,单纯颞区放电3例,颞外区放电2例,颞区合并颞外区放电4例。静注安定后癫痫性放电控制率在ASE组和PSE组差异无统计学意义(P>0.05)。6例患儿出现认知障碍。结论意识、语言障碍及精神行为异常为NCSE主要表现,发作期EEG是诊断的主要依据,及时有效地控制发作可减少对认知功能的损害。

The clinical features and prognosis of nonconvulsive status epilepticus in children:analysis of 12 cases.

Objective To study the clinical and EEG features,therapeutic response and prognosis of nonconvulsive status epilepticus(NCSE)in children.Methods The clinical and EEG data of 12 children with NCSE were analyzed and therapeutic response and prognosis were followed up.Results The median onset age of symptoms was(6.22±3.72)years.The median duration of seizures was 35h.There were 3 children with absence status epilepsy(ASE)and 9 with psychomotor status epilepsy(PSE).The clinical presentations of NCSE included impairment of consciousness(n=12),speech deterioration(n=9),behavior change(n=8),subtle motor findings such as eyelid twitching(n=5),illusion(n=2),eating more food than ever or thirsty(n=2),and vegetative manifestation(n=1).The ictal EEG of NCSE showed slow activity with generalized spike-and-slow wave discharges and slow waves(n=3),and continuous or periodic focal discharges(n=9),which was predominant with θ or δ activity(n=5),spike-and-slow wave discharges(n=4),discharges in temporal region(n=3),out of temporal region(n=2) and temporal with other regions(n=4).The control ratio of intravenous diazepam between ASE and PSE had no statistically significant difference(P > 0.05).Six children had cognitive impairment.Conclusion The main manifestations of NCSE are consciousness,speech deterioration and behavior change.The diagnosis can be made by ictal EEG.The prompt and effective manipulation of NCSE may reduce cognitive impairment.