5例癫痫性痉挛患者的临床诊治及脑电图特点分析

目的 探讨癫痫性痉挛患者的临床表现、脑电图(EEG)特点及治疗效果.方法 2009年7月～201 1年10月间,就诊于吉林大学第一医院癫痫门诊的5例诊断为痉挛性发作的癫痫患者,对其临床资料及长程录像脑电图监测结果,进行回顾性分析研究.结果 幼儿期发病的患儿3例,首先表现为部分性发作,后表现为成串样的点头,伴有双上肢抬起外展,两侧不对称,右侧肢体为著.老年期发病的癫痫性痉挛患者2例表现为一侧肢体短暂性屈曲样动作,呈串样发作,伴有肢体的僵硬,每天10余串发作,每串10余次.同步录像脑电图监测到1～2串痉挛发作,相应脑电见泛化性高波幅负相慢波,随后见低波幅快活动,相应肌电见爆发性肌电活动且电位递减,似“菱状”改变.结合其临床发作特点及相关脑电检查诊断为“癫痫症(痉挛性发作)”,给予抗癫痫药物治疗有效.结论 癫痫性痉挛并非仅见于婴儿West综合征,可由诸多严重的脑部疾病引起,常合并其他部分性或全面性发作,相对广谱AED仍为本病首选治疗方法.

Clinical and electroencephalogram characteristics of five patients with epileptic spasms

Objective To analyze the clinical and electroencephalogram characteristics and therapeutic response of epileptic spasms patients.Methods Clinical datas and long-term video EEG results were collected,and retrospective analysis of 5 epileptic spasms patients from July 2009 to October 2011 was performed.Results 3 cases began with partial seizure in early age,subsequent with clusters of nodding accompanied by two upper limb asymmetrical lifting.2 cases began with transient limb flexion accompanied by stiffness in old age.Long-term video EEG showed generalized high amplitude negative slow wave,then followed by low amplitude fast activity,and synchronized EMG showed explosive electromyographic activity and potential decrement,like "Ling form" change.Antiepileptic therapy was effective.Conclusion Epileptic spasm is not only in West syndrome,but also often combined with other partial or generalized seizure.Broad-spectrum AED is still the preferred treatment for this disease.