儿童孤独症患儿脑电图特征分析

目的：通过观察和分析儿童孤独症患儿脑电图（EEG）改变,探讨脑电图检查对儿童孤独症的诊断意义。方法：对115例儿童孤独症患儿的脑电图检查结果进行分析。结果：115例患儿,异常脑电图52例,异常率45．2％。轻度异常23例,表现为基本节律减慢,慢波多于同龄;中度和重度异常29例,其中局限行异常14例,出现痫样放电10例,局限性异常＋痫样放电5例。结论：EEG客观反映了儿童孤独症患儿的脑功能情况,对儿童孤独症有诊断价值     

常规脑电图在儿童孤独症综合康复治疗中的临床价值

目的:分析和评价常规脑电图(EEG)在孤独症谱系障碍(ASD)儿童综合康复治疗中的临床价值。方法:36例2~7岁ASD患儿,进行综合康复治疗3个月,比较治疗前后常规EEG、临床症状、智力和语言水平的变化情况。结果:治疗前有异常或界限EEG表现的ASD患儿治疗后ABC量表总分及感觉、交往、生活自理因子得分,CARS量表总分,韦氏智力测验中操作智商和总智商,0~6岁儿童神经心理发育量表(儿心量表)中智龄、精细动作、适应能力、语言和社交行为得分,S-S语言发育迟缓评定量各项得分均较治疗前有明显改善(P<0.05),且有5例患儿EEG表现转为正常(P<0.01)。而治疗前EEG正常表现的ASD患儿治疗后仅CARS量表分,操作智商和总智商,S-S语言发育迟缓量表中语言理解分和总分有改善(P<0.05),对智力发育(4岁以下)、临床症状(家长访谈角度)和言语水平(言语表达、言语符号、动作性课题)改善不佳(P>0.05)。结论:常规EEG检测可作为一种评价康复治疗后脑功能变化的方法,也可用于指导孤独症儿童综合康复治疗方案的选择和疗效的预测。     

儿童抽动障碍的临床与脑电图分析

目的:探讨抽动障碍(TD)患儿的临床及脑电图(EEG)特征。方法:对70例TD患儿的临床及EEG资料进行比较和回顾性分析。结果:70例TD患儿中EEG正常63例(90%),异常7例(10%)。其中4例表现为典型的癫癎样放电,另3例表现为阵发高幅θ节律。结论:本组病例EEG的异常率与患儿的发病性别、病程、分娩方式存在一定的对应关系,EEG可作为评估病情严重程度的客观依据。     

95例儿童孤独症临床分析

目的：探讨儿童孤独症的临床特征,展望相对应的干预措施。方法：调查孤独症患儿的父母文化的水平、城乡比例、首诊主诉、发病与就诊时间间隔。采用Gesell发育量表测定发育商。Car's量表进行症状行为评定,用社会生活能力量表进行适应性行为评定。检验分析孤独症行为与适应性行为的相关性。结果：孤独症患儿父母文化水平大多为初、高中以上文化。孤独症患儿城乡比例为：2．8：1。首诊主诉症状以语言障碍为主（占84％）。患者从发病到就诊时间平均延迟31个月。孤独症行为的严重程度与社会生活能力缺陷的程度无相关性,症状特点以语言障碍及社会交往障碍最为突出。作者对此进行了分析并提出早期干预及行为,语言训练的相应建议。     

214例儿童癫痫的临床及脑电图分析

众所周知，癫痫多在儿童期起病，儿童癫痢在临床表现、发作类型、疾病类型等方面均与成人有所不同，有其年龄的特殊性，并可随年龄变化而变化，多数预后良好。本文对1992年12月至2003年6月期间在我院就诊的214例儿童癫痫患者进行脑电图(EEG)描记，现将结果分析报告如下。     

64例儿童睡眠障碍脑电图及临床分析

1　临床资料6 4例均为本院 2 0 0 2年 1月至 2 0 0 2年 12月门诊及少量住院患者。男 4 4例 ,女 2 0例。年龄 3～ 12岁 ,平均 5 7岁。其中 3～ 4岁 11例 ,5～ 6岁 2 2例 ,7～ 10岁 2 8例 ,11岁 2例 ,12岁 1例。临床诊断夜惊 34例 ,睡行症 12例 ,梦魇 7例 ,睡眠障碍 (包括癫待排 ) 11例。病程半个月至 1年零8个月。发作频率长者 2～ 6个月 1次 ,短者一周 3～ 4次。发生于前半夜即入睡后 1～ 3h者 4 4例 ,发生于后半夜 2 0例。夜惊发作时患儿多为突然从睡眠中惊醒 ,大声哭喊 ,手足乱抓 ,伴随身体强烈扭动 ,表情紧张 ,呼吸急促 ,意识朦胧 ,双…     

儿童癫癎发作的临床特征与录像脑电图分析

目的：分析儿童癫痫发作的临床表现和录像脑电图(Video—EEG)特征。方法：对123例年龄9天至15岁癫痫患儿进行Video—EEG监测，记录并同步分析发作时EEG与临床表现。结果：123例中记录到568次发作，分三种类型。1、全面性发作53例201次发作：①婴儿痉挛18例中53次发作，发作期EEG表现为广泛低波幅快活动或高波幅慢波暴发与低电压抑制；②肌阵挛发作12例中79次发作，发作期EEG表现各导联多棘波、多棘慢波；③强直发作10例中24次发作，发作期EEG表现导联低波幅快节律、多棘慢波；④阵挛发作10例中39次发作，发作期EEG表现各导联棘慢波、尖慢波；⑤失神发作3例中6次发作，发作期EEG表现全导联3Hz棘慢波。2、部分性发作67例中339次发作．分别起源于额、中央、顶、颞、枕，其中38例191次发作为继发全身发作。3、混合发作3例中28次发作。结论：Video—EEG有助于临床医师对儿童癫痫的正确分型及指导治疗。     

儿童孤独症30例临床分析

本文对30例儿童孤独症的临床症状,病因及治疗进行初步分析,发现语言障碍,交往障碍最为常见且语言障碍最易为父母所注意,建议对妇幼保健部门及父母普及有关知识,在儿童进行体检时将语言发育及交往能力发育包括在内,以便早期发现,治疗。从30例病例分析似不支持社会心理因素是孤独症病因的学说,半数患儿用小量抗精神病药物治疗,短期内可望部分症状改善。     

儿童抽动障碍的临床与脑电图分析

目的：探讨抽动障碍患儿临床与脑电图的特征。方法：对135例抽动障碍患儿临床及脑电图资料进行了回顾性分析。结果：该组患儿抽动症状以面部及头颈部抽动为主，短暂性抽动症、慢性抽动症、多发性抽动症患儿异常脑电图的发生率分别为25．3％、44．1％、50．0％，短暂性抽动症异常脑电图出现率低于慢性抽动症及多发性抽动症，差异有统计学意义（P〈0．05）。结论：抽动症患儿脑电图的异常与病程的长短及严重程度存在一定的对应关系，脑电图可做为评估病变严重程度的客观依据之一。     

儿童多动综合征的临床与脑电图分析

目的:探讨脑电图对儿童多动综合征的诊断价值。结果:正常脑电图6例(17.1％),轻度异常12例(34.3％),中度异常14例(40％),高度异常3例(8.6％),脑电图学异常率为82.9％。结论:脑电图对儿童多动综合征的诊断和指导治疗有一定的帮助。     

78例儿童孤独症患者体感诱发电位分析

目的:通过观察和分析儿童孤独症患者体感诱发电位(SEP)的改变,探讨其在儿童孤独症诊断中的临床意义。方法:对1岁零8个月至8岁的78例孤独症儿童进行SEP检查,观察皮层第一个电位P40潜伏期及P40、N50、P60、N75波幅的改变。结果:78例孤独症患儿皮层电位P40潜伏期均有延长,其中双侧延长55例,单侧延长23例,并波幅分化差或左右不对称18例。结论:孤独症患者体感传导通路皮层电位潜伏期延长和波幅的改变,提示皮层下(包括脑干、丘脑)和相关皮层功能受损的可能,结合影像学检查,对评价神经系统功能及预后有一定的价值,对孤独症患儿临床诊断有帮助。     

38例过敏性紫癜患儿的临床病例分析

目的:分析过敏性紫癜(HSP)患儿的临床资料,总结该病的临床特征。方法:对38例HSP患儿流行病学及临床表现特征进行回顾性分析。结果:发病年龄在7~14岁者占73.68%,四季均有发病,10~12月份发病率占全年发病的68.42%。发病诱因中感染占68.42%,接触过敏原占13.16%。100%的患儿有皮肤紫癜,有关节症状,消化道症状和肾脏损害者分别占31.58%,47.36%和10.53%。结论:过敏性紫癜好发于秋冬季节,感染、过敏为其主要发病诱因,主要受累器官为皮肤、关节、胃肠道、肾脏,可单独或同时存在。     

孤独症谱系障碍儿童的睡眠行为

目的:探讨学前期和学龄期孤独症谱系障碍(autism spectrum disorders,ASD)儿童的睡眠行为的特点和差异。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的ASD儿童84名和年龄性别匹配的正常儿童91名,使用儿童睡眠习惯问卷(CSHQ)和一周睡眠日记,由儿童主要照顾者记录儿童的睡眠情况。依据CSHQ总分大于41分为睡眠不良,以具体条目中睡眠行为发生频率超过2晚/周的标准界定睡眠行为问题,分3～5岁和6～12岁两个年龄段比较ASD与对照组儿童在睡眠行为和习惯上的差异。结果:3～5岁ASD组儿童CSHQ的睡眠潜伏期[(2.1±0.8)vs.(1.6±0.7)]、睡眠持续情况[(5.4±1.7)vs.(4.8±1.3)]得分高于对照组,入睡困难(77.6%vs.49.0%)、睡眠量不足(63.3%vs.42.9%)、夜醒哭闹(34.7%vs.12.2%)及日间疲乏(36.7%vs.10.2%)的比例较对照组高(均P0.05)。6～12岁ASD儿童平时睡眠总时长短于对照组[(8.68±0.76)h vs.(9.33±1.00)h],CSHQ的入睡抵触[(10.1±2.8)vs.(8.6±2.5)]、睡眠潜伏期[(1.7±0.7)vs.(1.4±0.6)]与睡眠焦虑[(5.4±2.0)vs.(4.5±1.9)]得分高于对照组,入睡困难(54.3%vs.31.0%)、睡眠量不足(60.0%vs.35.7%)、与父母同睡(65.7%vs.38.1%)、入睡需陪伴(68.6%vs.35.7%)的比例较对照组高(均P0.05)。结论:ASD儿童普遍存在睡眠总量少、入睡困难等问题,学龄前期以夜醒后哭闹和白天疲倦较为突出,而学龄期则以睡眠焦虑较为明显。     

儿童14和6Hz正相棘波的临床意义

目的：对ＥＥＧ具有１４和６Ｈｚ正相棘波的儿童进行病因学和ＥＥＧ的分析，以评价其临床意义。方法：应用电视录相ＥＥＧ对２～１４岁各种症状儿童进行自然睡眠监测，分析正相棘波的出现率及相关因素。结果：２６２例各种症状的患儿中有３２例出现这种正相棘波，出现率为１２％。癫痫组、植物神经症状组和精神行为症状组儿童正相棘波的出现率无明显差别。对出现这种正相棘波的ＥＥＧ分析表明，伴随其他非特异性异常脑电现象者正相棘波出现率明显高于具有正常ＥＥＧ或癫痫样放电ＥＥＧ者（Ｐ＜０．０５）。结论：这种正相棘波是一种非特异性的异常脑电现象，无病因学方面的意义，和癫痫活动无关。     

Sleep problems in children with autism

Autism is a developmental disability characterized by severe deficits in social interaction and communication, and the presence of repetitive-ritualistic behaviors. Sleep problems are frequently reported by parents of children with autism with prevalence estimates of 44-83% for sleep disorders in this population. To better understand sleep in autism, we surveyed sleep problems in 210 children with autism using a Likert-based questionnaire for parent report. The most frequently reported sleep problems included difficulty in falling asleep, restless sleep, not falling asleep in own bed, and frequent wakenings. Least frequently reported sleep problems were sleep walking, morning headaches, crying during sleep, apnea, and nightmares. When surveys were divided into mental retardation (MR)/not MR categories, no significant differences were identified in frequencies of reported sleep problems except for waking at night which occurred much more frequently in the MR group. There was also no difference in sleep problems related to age of the child other than nocturnal enuresis. An association was noted between certain medical problems and sleep problems. Vision problems, upper respiratory problems, and runny nose were associated with decreased nighttime sleep. Vision problems, poor appetite, and poor growth were associated with increased nighttime waking. Poor appetite and poor growth were associated with decreased willingness to fall asleep. This study confirms a high prevalence of sleep problems reported by parents of children with autism and points to the need for more systematic research as an initial step in developing treatment strategies.     

儿童极度纺锤波脑电图的临床意义

目的:探讨极度纺锤波的临床意义。方法:对498例患儿进行自然睡眠脑电图监测,对具有极度纺锤波的患儿进行智力测验,将脑电图与病种和智测结果结合分析。结果:39例患儿出现极度纺锤波,这种波型在癫、脑性瘫痪、热性惊厥、抽动症疾病中的出现率无明显差别。极度纺锤波的患儿,智力低下的出现率为43.5%,明显高于对照组(16%,P<0.05)。结论:极度纺锤波是一种非特异性的异常脑电现象,无病因学方面的差异,可能是一种脑功能障碍的反映。     

Partial 6p trisomy associated with infantile autism

Partial trisomy 6p with duplications ranging from 6p21 to 6p25-pter is emerging as an established syndrome. We report a case of duplication of 6p (6p23-pter) and deletion of 2q37-qter. Features characteristic of 6p partial trisomy present in the patient are low birthweight, and mental and developmental retardation. Major facial features include prominent forehead, flat occiput, multiple ocular abnormalities, low-set ears, prominent nasal bridge, long philtrum and small pointed mouth. Repeated examinations of the patient from birth to the age of over 5 years revealed that he has infantile autism. Since autistic children are generally not associated with chromosome anomalies, in view of the present case, it is suggested that karyotypic analysis be considered for such children. Where possible, extended study for autism in 6p trisomic children may also be desirable.     

Frequency of the fragile X syndrome in infantile autism

In a Swedish multicenter study, 102 cases of infantile autism (I.A.) were examined for fragile X (q27). The fragile X syndrome was observed in 13 of the 83 (16%) boys with I.A., but in none of the 19 girls with I.A.     

儿童髓质海绵肾11例临床分析

目的分析儿童期发病的髓质海绵肾（MSK）的临床特点。方法回顾性分析1990年1月至2011年4月华中科技大学同济医学院附属同济医院儿科影像学诊断的MSK患儿的临床表现、实验室检查、治疗和随访等资料。结果 11例MSK患儿进入分析,男9例,女2例,年龄3个月至11岁,平均年龄4.54岁,〉3岁6例。①以泌尿系统症状（多尿、尿频、尿急、尿痛、排尿不畅、水肿）就诊5例,以泌尿系统外症状（发热、呕吐、生长发育落后、腹泻、咳嗽）就诊6例。尿蛋白阳性9例,镜下血尿8例,白细胞尿7例。合并远端肾小管酸中毒者9例,泌尿系统感染6例,双肾多发性结石7例,肾性贫血4例,双肾多发性钙化3例,Caroli＇s病1例,生长发育落后5例。②5/9例腹部X线片显示双肾髓质区可见较对称、呈扇状钙质影沿肾乳头分布,大小略显不等;10/11例腹部B超检查示双肾髓质回声增强,其中7例显示双肾内有多个强回声团,后方伴声影,肾积水2例,且均为右肾;4例肾盂静脉造影检查均显示肾锥体内集合管扩张,呈扇形、条纹状或葡萄串状改变,受损肾组织达1～3个椎体,双侧呈对称性病理改变;2例CT检查均可见双肾多发散在小结石成簇状排列。③11例入院后均予纠酸、补钾、抗感染和排石等对症治疗,出院后予长期口服枸橼酸钠钾。1例失访,10例随访（5.2±1.9）年,6例发展为肾功能不全,2例身高仍明显落后于同龄儿童。结论儿童期发病的MSK可以泌尿系统外症状起病,且可合并其他肾内肾外疾病。诊断主要依据影像学检查,积极治疗有可能延缓肾功能逐步恶化。     

Sleep in children with autism with and without autistic regression

The purpose of the present investigation was to characterize and compare traditional sleep architecture and non-rapid eye movement (NREM) sleep microstructure in a well-defined cohort of children with regressive and non-regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty-two children with non-regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5-10years, underwent standard overnight multi-channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens' Sleep Habits Questionnaire-CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non-regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non-regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non-regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro- or from a microstructural viewpoint.