氢质子磁共振波谱检测小儿热性惊厥及癫癎临床价值研究

目的 探讨氢质子磁共振波谱(proton maglletic resonance spectrpscopy,1H-MRS)检测在热性惊厥(febrile seizure,FS)及癫瘖(epilepsy,EP)中的临床应用价值及意义.方法 2006-2007年收治惊厥患儿共41例,其中FS组25例.其中单纯性热性惊厥(simple febrile seizure,SFS)组15例及复杂性热性惊厥(complex febrile sei-zure.CFS)组10例;EP组16例,按有无合并热性惊厥史分为伴有热性惊厥组7例和不伴热性惊厥组9例.对热性惊厥和癫癎患儿进行常规头颅磁共振(MRI)及颞叶海马区1H-MRS检查,并选择6例神经系统正常儿童作对照组.1H-MRS检测指标:N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酸-谷氨酰胺复合物(Glx)和乳酸(Lac)的信号强度,计算NAb/(Cho Cr)和Lac/Cr的比值,并进行比较.结果 头颅MRI检查结果:FS组及对照组均正常,EP组除1例髓鞘发育不良外余均正常.1H-MRS检查结果显示:NAA(Cho Cr)比值SFS组为0.71±0.05.CFS组为0.65±0.04,EP组为0.62±0.04(其中伴有热性惊厥史EP组为0.60±0.03,不伴有热性惊厥史的EP组为0.64±0.04),对照组为0.73±0.05.NAA/(Cho Cr)比值在CFS组与EP组之间无明显差异(P>0.05),但两组均低于对照组(P<0.01);CFS组明显低于SFS组及对照组(P<0.01),但后两者差异无统计学意义(P>0.05);伴有热性谅厥史的EP组低于不伴有热性惊厥史的EP组(P<0.05). Lac/Cr比值SFS组(0.32±0.21)和CFS组(0.63±0.30)不仅高于对照组(0.05±0.04)(P<0.05),也明显高于EP组(0.11±0.09)(P<0.05);CFS组Lac/Cr高于SFS组,P<0.01;EP组Lac/Cr与对照组比较无明显差异.结论 (1)NAA/(Cho Cr)比值是反映脑损伤的客观指标,该指标在CFS及EP患儿脑组织中下降,提示存在神经元丢失或功能失常.(2)Lac/Cr比值是反映脑急性缺氧的指标,该指标在SFS及CFS患儿脑组织中升高,提示惊厥过程中存在脑局部缺血,即使是短暂单次的惊厥发作亦存在脑损伤.(3)1H-MRS作为一项无创的检查,能更敏感地发现FS及EP惠儿的早期脑损伤.有助于弥补MRI的不足及其他有创检查的损伤,为FS及EP患儿治疗、评估预后提供客观依据.     

氢质子磁共振波谱在热性惊厥中的临床应用

目的应用氢质子磁共振波谱(1H-MRS)检测热性惊厥(FS)患儿脑组织生化代谢物,了解FS发作后脑损伤情况,探讨1H-MRS在FS中应用的意义。方法对25例FS患儿和6例神经系统正常儿童进行常规头颅MRI和颞叶海马区的1H-MRS检查。25例FS患儿中,15例为单纯性热性惊厥(SFS),10例为复杂性热性惊厥(CFS)。检测指标为N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酸-谷氨酰胺复合物(Glx)和乳酸(Lac)的信号强度,计算并比较NAA/(Cho Cr)和Lac/Cr的比值。结果头颅MRI检查结果为FS组及对照组均未显示异常。1H-MRS检测结果为NAA/(Cho Cr)比值,SFS组为0.71±0.05,CFS组为0.65±0.04,对照组为0.73±0.05,CFS组明显低于SFS组及对照组(Pa<0.01),但后二者之间无明显差异(P>0.05)。Lac/Cr比值SFS组(0.32±0.21)和CFS组(0.63±0.30)高于对照组(0.05±0.04)(Pa<0.05),且CFS组高于SFS组(P<0.01)。结论1H-MRS作为一项无创检查,能更敏感地发现FS患儿的早期脑损伤,为FS尤其是CFS患儿的治疗、评估预后提供客观依据。     

癫癎和热性惊厥患儿血清褪黑素水平的变化及其临床意义

目的：探讨癫癎和热性惊厥患儿血清褪黑素水平的变化及其临床意义,为褪黑素用于癫癎和热性惊厥的治疗提供依据。方法：该研究分为对照组,即上呼吸道感染发热无惊厥患儿;热性惊厥组,其中又分为单纯性热性惊厥(SFS组)和复杂性热性惊厥(CFS组);癫癎组。采用酶联免疫吸附法(ELISA)分别测定各组血清褪黑素水平。结果：癫癎和复杂性热性惊厥患儿血清褪黑素水平分别为8.66±1.38和14.91±2.61 ng/L,均显著低于对照组的23.93±2.01 ng/L,差异有显著性(P<0.01),单纯性热性惊厥患儿血清褪黑素水平为20.72±2.54 ng/L,低于对照组,但差异无显著性意义(P>0.05);癫癎患儿血清褪黑素水平明显低于热性惊厥患儿,差异有显著性(P<0.01)。结论：癫癎和复杂性热性惊厥患儿血清褪黑素水平降低。补充外源性褪黑素可能是治疗儿童癫癎和热性惊厥的一个新途径。［中国当代儿科杂志,2009,11（4）：288-290］     

偏侧惊厥-偏瘫-癫(间)综合征的临床特点及诊断

目的探讨偏侧惊厥-偏瘫-癫癎(HHE)综合征的临床特点及诊断。方法对5例HHE综合征患儿的临床资料进行回顾性分析,总结临床特征及其发病的危险因素,进行必要的辅助检查,包括头颅CT和(或)MRI、脑电图及诊断性智力测定或精神运动发育评价。结果4例4岁内起病,3例伴热性惊厥,最长惊厥时间均在2 h以上,并惊厥侧肢体偏瘫。5例均在偏瘫后2年内出现癫癎反复发作。4例为局限性运动发作,1例为精神运动性发作。5例均存在智力障碍或精神发育迟滞。头颅MRI检查4例发现左侧海马硬化,1例CT示右半球萎缩。脑电图均异常,4例见异常放电,1例示明显不对称。5例均予卡马西平为主的药物治疗,癫癎发作得到控制或部分控制。结论HHE综合征是持续偏侧惊厥导致的偏瘫-癫癎综合征,海马硬化可能是反复癫癎所致海马的继发性损伤,而非癫癎的起源灶。应提高对该病的认识,早期正确处理惊厥持续状态将减少HHE综合征发生。     

儿童症状性癫(癎)308例病因分析

目的 探讨儿童症状性癫(癎)常见病因及不同年龄段病因构成特点.方法 以2004年1月至2007年1月在湖南省儿童医院神经内科住院的308例症状性癫(癎)患儿为病例组,同期住院的202例非(癎)性发作患儿为对照组,采用前瞻性调查方法并通过自制问卷调查表对两组患儿的家长进行调查;对所有病例均进行了详细体格及神经系统检查;所有患儿均查脑电图、头颅CT和(或)头颅MRI.采用单因素和多因素分析;对各组病因构成比进行?检验.结果 (1)单因素分析显示围生期损伤、先天性脑发育异常、颅内感染、热性惊厥、神经皮肤综合征、颅脑外伤等与儿童症状性癫(癎)相关(P<0.05).将其引入多因素Logistic回归模型,显示儿童症状性癫(癎)与围生期损伤、先天性脑发育异常、颅内感染、热性惊厥有显著相关.(2)相似文献   

儿童睡眠中癫癎性电持续状态的相关因素分析

目的：儿童睡眠中癫癎性电持续状态（ESES）的病因不明，该研究旨在分析ESES的相关因素，为有效预防和治疗此病提供依据。方法：以唐山市妇幼保健院2000年1月至2006年7月确诊为ESES的30例患儿为研究对象，选择与ESES组相匹配的非ESES癫癎组30例为对照组，设计问卷调查表获取资料。对癫癎发作类型、癫癎样放电起源部位、家族史及围生期情况、影像学、智商、癫癎综合征等多项因素采用χ2检验及t检验进行分析。结果：ESES组与对照组在癫癎家族史、智力低下及癫癎综合征、语言障碍之间比较差异有显著性（P<0.05）。癫癎发作类型、癫癎样放电起源部位、父母育龄、患儿出生史、热性惊厥家族史、影像学异常两组间差异均无显著性意义（P＞0.05）。既往患热性惊厥、脑瘫、颅内感染两组间比较，差异亦无显著性意义（P＞0.05）。结论：ESES与癫癎家族史、癫癎综合征、智力水平及语言障碍相关。［中国当代儿科杂志，2009，11（2）：110-112］     

氢质子磁共振波谱和磁共振弥散加权成像早期诊断新生儿缺氧缺血性脑病的价值探讨

目的 探讨磁共振弥散加权成像(DWI)的表观弥散系数值(ADC)和氢质子磁共振频谱(1H-MRS)在评价足月新生儿缺氧缺血性脑病(HIE)中的临床价值.方法 32例足月HIE患儿和同期10例健康足月新生儿生后10 d内行DWI和1H-MRS扫描,记录代谢产物1H-MRS波峰下面积和ADC值,并进行比较.结果 (1)HIE组右侧基底节和额叶的乳酸/肌酸比值(Lac/Cr)较对照组升高,N乙酰天门冬氨酸/肌酸比值(NAA/Cr)、胆碱/肌酸比值(Cho/Cr)较对照组降低,差异有统计学意义(P均<0.05);轻度、中度、重度HIE组右侧基底节和额叶的Lac/Cr比值逐渐升高,均高于对照组(P均<0.05),右侧基底节NAA/Cr、Cho/Cr比值逐渐降低,均低于对照组(P均<0.05).HIE的临床分度与右侧基底节和额叶的Lac/Cr呈正相关,与右侧基底节的NAA/Cr、Cho/Cr呈负相关.(2)HIE组左右两侧豆状核及右侧额叶深部白质ADC值较对照组降低,差异有统计学意义(P<0.05);HIE临床分度与左右两侧豆状核及右侧额叶深部白质的ADC值为负相关.(3)右侧基底节NAA/Cr与左右两侧豆状核ADC值呈正相关.结论 DWI和1H-MRS对新生儿HIE的临床诊断有重要临床意义,将两者结合可更好地评价脑损伤的严重程度,为临床诊疗提供有力依据,值得深入研究及推广.     

癫癎患儿危险因素对照分析

目的 探讨与儿童期癫(癎)发生有关的危险因素及其对癫(癎)发病率的影响.方法 2007年1-6月在华西第二医院神经门诊就诊160例癫(癎)患者为病例组.男88例,女72例;年龄1个月～16岁[(7.0±4.7)岁].癫(癎)儿童均有2次以上无诱因惊厥发作,由脑电图辅助诊断.排除脑性瘫痪、小头畸形、智力低下、先天性畸形、肿瘤性疾病者.同期华西第二医院儿童保健门诊的神经系统正常(根据病史及体格检查无癫(癎)、生长发育正常、无脑性瘫痪和其他神经系统疾病)的儿童150例为健康对照组.男72例,女78例;年龄2个月～16岁[(6.3±4.5)岁].根据其年龄和性别,作为对照进行病例对照研究.通过＜癫(癎)患者调查表＞对患儿及其父母进行病史询问获得相关数据资料,包括高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史、中枢神经系统感染史及近亲结婚史等,应用SPSS 13.0软件归纳分类后进行x2检验,P＜0.05为有显著性差异.结果 病例组高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史与健康对照组比较均有显著性差异(P=0.01,0.01,0,0.02),分别使癫(癎)发生危险性增加了2.72、3.75、3.61和2.47倍;而中枢神经系统感染史、近亲结婚与健康对照组比较无显著性差异(P=0.73,1.0).结论 高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史是增加本地区儿童癫(癎)发病率的危险因素,其中高热惊厥史、头部外伤史和癫(癎)家族史对于癫(癎)发病率的增加较为重要,而中枢神经系统感染史、近亲结婚不增加儿童癫(癎)的发病率.     

儿童中央-颞区放电的良性癫癎与热性惊厥的关系

目的 研究中央—颞区放电的小儿良性癫痫(BCECT)和热性惊厥的关系，探讨BCECT和热性惊厥的关系。方法 通过问卷对26例BCECT患儿的家族史及热性惊厥家族史进行调查。并做VEEG、头颅CT或MRI。同时选择26例年龄相当的正常儿童做对照。结果 26例BCECT患儿的头颅CT或MRI均未发现异常，仅2例既往有热性惊厥史，与人群中热性惊厥发病率相比无差异。26例BCECT患儿的癫痫家族史和对照组相比无显著差异(P＞0.05)，但其热性惊厥家族史的发生率却明显高于对照组(0．0l＜P＜0．05)。结论 证BCECT和热性惊厥有密切关系，二者在发生学上可能有同源性。     

癫癎患儿外周血中调节性T细胞的变化及其临床意义

目的：研究CD4+ CD25+ Foxp3+ 调节性T细胞（Treg细胞）在癫癎患儿外周血的表达水平,探讨其在癫癎发病机制中的作用。方法：采用流式细胞术分别检测41例癫癎患儿和38例健康儿童外周血Treg细胞占CD4+ T细胞的比例,及CD4+ T细胞、CD8+ T细胞、自然杀伤细胞（NK）、B细胞分别占淋巴细胞的比例。结果：癫癎组患儿外周血Treg细胞比例、CD4+ T细胞比例、CD4+ /CD8+ 比值分别为（2.4±0.5）%、（35±5）%、1.32±0.24,较对照组的（6.1±1.2）%、（38±4）%、1.60±0.24显著降低（P<0.05）;而癫癎组CD8+ T细胞比例、NK细胞比例、B淋巴细胞比例分别为（27±3）%、（11.1±5.1）%、（24±9）%,较对照组的（24±3）%、（8.5±1.9）%、(16±5)%显著升高（P<0.05）。结论：癫癎患儿外周血中存在 Treg 细胞比例异常,提示免疫机制可能参与了癫癎的发生和发展。     

EXPERIENCES ON THE USE OF DIPROPYLACETATE IN THE TREATMENT OF CHILDHOOD EPILEPSY

ABSTRACT. The antiepileptic efficiency of dipropylacetate (DPA) was studied in 80 epileptic children who suffered either from seizures resistant to previous medication, so-called idiopathic epilepsy or progressive myoclonus epilepsy. The average peroral daily dosage of DPA was 21 mg/kg divided into 2 to 3 doses. DPA was most effective in cases with 1) so-called idiopathic epilepsy (genuine petit mal, photogenic epilepsy, myoclonic petit mal in older children), 2) seizures beginning in later childhood years, 3) photosensitive and hyperventilation-sensitive seizures, 4) EEG showing symmetric generalized spike-slow wave complexes provoked by photostimulation, 5) EEG without generalized disturbance or focal findings, 6) normal neurological and mental status, 7) progressive myoclonus epilepsy. DPA may thus be recommended for the treatment of the above-mentioned cases and, due to good treatment results, also tried in other types of epilepsy.     

儿童颞叶癫癎及特发性癫癎对认知功能及情绪的影响

目的 评估儿童颞叶癫癎及特发性癫癎对认知及情绪的影响,并探索影响认知的危险因素。方法 回顾性分析38例颞叶癫癎、40例特发性癫癎患儿资料,招募42例健康儿童为对照组,每位受试者均行以下神经心理测试：蒙特利尔认知测评量表 （MoCA）、言语流畅性、数字广度、木块图、儿童社交焦虑量表 （SASC）、儿童抑郁障碍自评量表 （DSRSC）。结果 与对照组比较,颞叶癫癎组及特发性癫癎组MoCA、言语流畅性、数字广度、木块图得分均较低 （P <0.05）;SASC、DSRSC 得分均较高 （P <0.05）。颞叶癫癎组的MoCA、言语流畅性、数字广度、木块图得分均低于特发性癫癎组 （P <0.05）,SASC、DSRSC 得分高于特发性癫癎组 （P <0.05）。颞叶癫癎组的MoCA 得分与SASC、DSRSC 及发作频率呈负相关 （r=-0.571,-0.529,-0.545,P <0.01）;特发性癫癎组的MoCA 得分与SASC、DSRSC 及发作频率呈负相关 （r=-0.542,-0.487,-0.555,P <0.01）。结论 颞叶癫癎、特发性癫癎患儿的整体认知及言语、记忆、执行功能均受损,并合并焦虑抑郁,尤其以颞叶癫癎更明显。较高水平的焦虑、抑郁及发作频率是影响认知的危险因素。     

Is the International League Against Epilepsy classification of epileptic syndromes applicable to children in Estonia?

The concept of the epileptic syndrome has had a practical and research impact on the management of patients with epilepsy. The aim of the present study was to verify the applicability of the International Classification of Epilepsies and Epileptic Syndromes in children and adolescents in Estonia. A population-based study was performed between January 1995 and December 1997 in seven counties. Only cases involving children between the ages of 1 month and 19 years with at least two unprovoked seizures were included. In all, 560 children and adolescents were referred to the Children's Hospital of the University of Tartu. A syndrome diagnosis was made in 550 (98.2%) cases: (49.4%) were localization-related (6.4% idiopathic, 18.9% symptomatic, 24.1% cryptogenic). Benign childhood epilepsy with centrotemporal spikes was present in 33 (5.9%) and childhood epilepsy with occipital paroxysms in three (0.5%); 48.4% were generalized (28.8% idiopathic, 5.7% cryptogenic or symptomatic, 14% symptomatic). Childhood absence epilepsy was present in 6.4%, juvenile absence in 2.0%, juvenile myoclonic in 0.7% and epilepsy with generalized tonic-clonic seizures on awakening in 17.7%. West syndrome was diagnosed in 1.4%, Lennox-Gastaut syndrome in 2.9% of the cases. In 0.4% of the cases it was undetermined whether seizures were focal or generalized. In 8.8% of the cases there were atypical features so they were classified as 'other symptomatic generalized epileptic syndromes not defined above' and 1.8% of the cases were unclassified. Specific neurological diseases were diagnosed in 5.0% of cases. Thus, the International Classification of Epilepsies and Epileptic Syndromes was very applicable to children and adolescents in Estonia.     

卡马西平、丙戊酸钠、托吡酯对3～12岁癫癎儿童骨代谢的影响

目的探讨抗癫癎(EP)药物(AEDs)卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)对EP患儿骨代谢影响。方法实验组为90例3～12岁原发性EP患儿,根据治疗药物不同随机分为CBZ、VPA、TPM组各30例。除口服上述药物外未予其他任何药物治疗,疗程6～12个月。于治疗前和治疗后3、6个月分别测定骨密度(BMD)、骨碱性磷酸酶(BAP)、血钙、磷、碱性磷酸酶(ALP)。对照组为30例未治疗原发性EP患儿,同期检测上述指标。对上述骨代谢指标进行评价。结果实验组治疗前后BMD、BAP、钙、磷、ALP与对照组比较无显著性差异(Pa>0.05)。实验组CBZ、VPA、TPM治疗前后5种骨代谢指标比较亦无显著性差异(Pa>0.05)。结论短期服用CBZ、VPA、TPM对3～12岁EP患儿骨代谢无影响。     

Prevalence of Celiac Disease in Turkish Children with Idiopathic Epilepsy

Objective: This study has examined the prevalence of celiac disease in Turkish children with idiopathic epilepsy. Methods: Children with idiopathic epilepsy were screened for celiac disease using the IgA anti-tissue transglutaminase antibody and compared with the healthy control group in order to find the association of celiac disease (CD) with idiopathic epilepsy. Upper gastrointestinal endoscopy and small intestinal biopsies were offered to all antibody-positive patients. Findings : A total of 214 children with the diagnosis of idiopathic epilepsy and 166 healthy children as control group were studied. Of the patients recruited, 55.1% had generalized epilepsy, and 44.9% had partial epilepsy. In 33 patients with partial epilepsy, electroclinical features were consistent with a diagnosis of childhood partial epilepsy with occipital paroxysms (CPEO). Two of 33 patients with CPEO had positive IgA anti-tissue transglutaminase antibodies in serology. Pathological examination of small intestinal biopsy specimens showed total villous atrophy in both of them. The prevalence of celiac disease among children with idiopathic epilepsy and CPEO was 0.9% and 6%, respectively. Conclusion: The results of the present study revealed that prevalence of CD is increased in children with epilepsy. On the other hand, as high as 6% prevalence of CD among patients with CPEO found in this study should be kept in mind and the clinicians should be aware of this association.Key Words: Celiac Disease; Epilepsy; Occipital Paroxysms     

学龄期局灶性发作癫患儿睡眠结构的变化

目的研究学龄期局灶性癫患儿发作间期睡眠结构的变化。方法应用Solar2000N神经中央监护系统对23例6～12岁局灶性癫患儿(男15例,女8例)及15例年龄、性别与之相匹配的健康儿童(健康对照组,男11例,女4例)进行全夜自然睡眠多导监测,并将23例局灶性癫患儿按照样放电出现部位(额叶癫组、颞叶癫组、枕叶癫组),发作好发时间(睡眠发作组、清醒发作组、睡眠+清醒发作组)及服用抗癫药物类型(卡马西平治疗组,卡马西平+托吡酯治疗组)进行分组,应用SPSS13.0软件分析各组患儿与健康儿童之间各项睡眠参数的差异。结果与健康对照组比较,学龄期局灶性癫患儿非快速眼动(NREM)睡眠1期比例延长(P<0.05),慢波睡眠(SWS)比例显著减少(P<0.01);额叶癫组各项睡眠参数与健康对照组比较差异无统计学意义,颞叶癫组患儿NREM睡眠1期比例及觉醒时间延长(Pa<0.05),枕叶癫组SWS比例与健康对照组比较差异有统计学意义(P<0.05);睡眠发作组觉醒次数增加(P<0.05),NREM睡眠1期比例增加(P<0.05),清醒发作组SWS比例减少(P<0.05);卡马西平+托吡酯组与未服药组比较,...     

Antinuclear antibodies and glutamic acid decarboxylase antibodies in children with refractory epilepsy

BackgroundIncreased prevalence of antinuclear antibodies (ANA) and auto glutamic acid decarboxylase antibodies (GADA) ratio have been reported in patients with epilepsy. Anti-GAD antibodies (GADA) were first implicated in the pathogenesis of some neurological diseases including epilepsy.The aim of the studyTo determine the occurrence of GADA and ANA in the serum of children with refractory epilepsy.Patients and methodsForty children with refractory epilepsy 25 males and 15 females, mean age 9.17 ± 3.4 years were selected for this study. Patients with refractory epilepsy had recurrent seizures for more than 18 months with no more than a 3-month seizure free period during those 18 months and failure of at least two appropriate AEDs with proper doses, good compliance and within normal therapeutic range. Twenty children with controlled idiopathic epilepsy 15 males and 5 females newly diagnosed as suffering from various types of seizures generalized and partial types, mean age 10.1 ± 3.1 years were also included in this study. These children with idiopathic epilepsy were included in this study for comparison with children with refractory epilepsy as regard to the serum ANA and GADA.ResultsChildren with refractory epilepsy had high-serum levels of GADA and ANA in comparison to children with idiopathic epilepsy (P < 0.001), also there was a significant correlation between the duration of seizures and the serum levels of ANA and GADA in children with refractory epilepsy.ConclusionChildren with refractory epilepsy had high-titer of GADA and ANA. The finding confirmed the association between high GADA, ANA and refractory epilepsy suggesting an immunologic origin of refractory epilepsy.     

儿童枕叶癫癎的临床及脑电图特征

目的总结儿童枕叶癫癎(COE)的临床和脑电图(EEG)特征及预后。方法对43例COE患儿的临床资料进行回顾性分析。结果起病年龄5个月-13岁;癫癎发作表现为眼球偏转20例,呕吐15例,头偏转14例,头痛10例,口咽部或手自动症9例,黑朦8例,视幻觉7例,眼睑扑动7例,眼球阵挛3例;继发半侧阵挛11例,继发全身性发作18例。头颅影像学异常15例。有明确脑损伤病史和／或头颅影像学检查证实枕叶有病变者23例,诊断为症状性COE,其余20例符合特发性COE。发作间期EEG有癎样放电41例,其中位于枕区19例,枕、后颞区15例,少数可在枕区以外。15例记录到发作期EEG。40例随访1～9 a,其中特发性19例,对抗癫癎药物疗效好,17例无复发,其中11例已停药。症状性COE对抗癫癎药物疗效欠佳,发作完全控制仅8例。结论COE发作的临床特点为跟球偏转、视觉症状、呕吐、头痛、眼睑扑动;发作间期EEG放电主要在枕区或枕、后颞区,少数可在枕区以外;特发性COE预后优于症状性COE。     

Topiramate as a new antiepileptic drug in epileptic children in Iran

Objective It is known that current antiepileptic drugs cannot control seizures in 20–30% of patients. The aim of this study was to evaluate the efficacy and safety of topiramate (TPM) as add-on therapy in intractable epileptic children in Iran. Methods As a quasi- experimental (before and after) study, 42 iranian children aged 1–15 years, 28 boys and 14 girls with refractory seizures seeking treatment were recruited to be subjects of this study. Results Type of seizures of those 42 epileptic children were as follows: L.G.S. (n=14), idiopathic epilepsy (n=8), symptomatic epilepsy (n=16) and progressive myoclonic epilepsy (n=4). At the end of three months of treatment in which topiramate was used concomitantly with previous AED, 17% became seizure free, 26% had more than 50% reduction of seizure frequency and 5% of them had increasing seizures. Therefore, the drug is statistically significant in seizures reduction. The efficacy of the drug was statistically significant in idiopathic and symptomatic epilepsy. The author’s did not notice any serious side effects such as: hematologic abnormality, hepatotoxicity and nephrotoxicity. Conclusion This study supports efficacy and safety of TPM in controlling of intractable epilepsy in children and indicates the drug should be considered as an add-on therapy in the management of refractory epileptic syndromes.