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。     

伴中央-颞区棘波的儿童良性癫35例临床和脑电图特征

目的探讨伴中央-颞区棘波的儿童良性癫(BECTS)的临床和脑电图(EEG)特征。方法对2003年7月-2008年12月在本院癫门诊就诊的35例BECTS患儿的临床资料、EEG结果、药物治疗反应及预后进行回顾性分析。结果本组35例BECTS患儿的起病年龄为2.5～14.0岁,其中6～10岁为发病高峰(62.9%)。表现为局限性发作22例:一侧面部抽搐、流涎、咽喉发声、肢体强直或阵挛,部分继发全面性强直阵挛发作。仅表现为全面强直阵挛发作者13例。发作与睡眠密切相关,26例仅在睡眠期(包括午睡)发作,且多出现于入睡后不久或清醒前。所有患儿发作间期EEG背景活动正常,可见一侧或双侧中央-颞区尖波/棘波,发放频度于入睡后明显增加,睡眠期EEG监测可提高阳性率。应用小剂量抗癫药物单药治疗疗效好,25例在用药3～4个月停止发作,本组33例已停止发作,停止发作的年龄为4.5～16.0岁,12例已停止药物治疗。结论BECTS多发生于学龄期儿童,表现为局限性发作,也可全面泛化,发作与睡眠密切相关,睡眠期EEG监测具有重要诊断价值,EEG表现为一侧或双侧中央-颞区尖波/棘波,小剂量抗癫药物单药治疗反应良好,预后一般良好。     

Standardized Screening for Depression in Pediatric Epilepsy

IntroductionDepression is a common comorbidity of epilepsy that is under-recognized and under-diagnosed. To improve recognition, a brief screening tool, the Neurological Disorders Depression Inventory-Epilepsy-Youth (NDDI-E-Y) was implemented in a level-IV pediatric epilepsy clinic.MethodThis quality improvement is a pre-post design measuring the impact of standardized depression screening, via the NDDI-E-Y tool, in youth 12-17 years with epilepsy. Those with positive screens, scores > 32, received social work evaluation and mental health resources. Education was provided to all patients in standard discharge paperwork.ResultsOf N = 176 patients evaluated, n = 112 met criteria to complete the NDDI-E-Y. Fifteen percent (n = 17) of patients had positive screens, suggesting that they are at risk for depression.DiscussionDepression is a challenge when managing patients with epilepsy and may impact their quality of life and seizure control. Routine depression screening is recommended and feasible in the outpatient setting with a standardized work process.     

儿童癫(癎)的磁共振成像研究进展

随着MRI技术的进展,MRI在儿童癫(癎)的定位、定性诊断以及术前脑功能评估等方面发挥越来越重要的作用.MRI研究进展主要表现在以下几个方面:1.传统MRI形态学成像中高场强MR仪、相控阵线圈以及定量技术的应用;2.MRI波谱成像、弥散成像和弥散张量成像以及血氧水平依赖成像等功能、代谢水平成像;3.MRI与正电子发射断层成像以及脑磁图等技术的联合应用等.     

应用拉莫三嗪治疗不同类型癫(癎)130例

目的 探讨拉莫三嗪(LTG)单药及联合用药治疗不同类型癫(癎)发作的疗效.方法 选择疗程在6个月以上共130例不同发作类型的癫(癎)患儿,口服LTG单药或联合用药治疗,年龄5个月～17岁,进行开放性自身对照临床试验.1.单药组LTG初始量:≥12岁者25 mg·d-1,每周递增25 mg·d-1;＜12岁者0.5～2.0 mg·kg-1·d-1,每周递增0.5～2.0 mg·kg-1·d-1.2.联合组:原用丙戊酸钠、托吡酯、左乙拉西坦者,起始量:≥12岁者12.5 mg·d-1,每周递增12.5 mg·d-1; ＜12岁者0.15～0.30 mg·kg-1·d-1,每周递增0.3 mg·kg-1·d-1.原用苯巴比妥、卡马西平、奥卡西平者,起始量:≥12岁者50 mg·d-1,每周递增50 mg·d-1; ＜12岁者0.15～0.30 mg·kg-1·d-1,每周递增0.3 mg·kg-1·d-1.以上均4～8周达维持量.结果 130例中107例有效控制发作,总有效率达82.31%,其中62例完全控制发作;单药组和联合组疗效比较差异无统计学意义(P>0.05).出现不良反应14例,其中皮疹9例,嗜睡、头痛、头晕、食欲减少、烦躁各1例.结论 LTG是一种广谱、高效、安全的抗癫(癎)药物,无论单药或者联合用药治疗均有较好疗效.     

Electroencephalography in neonatal epilepsies

Neonatal epilepsies – neonatal seizures caused by remote symptomatic etiologies – are infrequent compared with those caused by acute symptomatic etiologies. The etiologies of neonatal epilepsies are classified into structural, genetic, and metabolic. Electroencephalography (EEG) and amplitude‐integrated EEG (aEEG) are essential for the diagnosis and monitoring of neonatal epilepsies. Electroencephalography / aEEG findings may differ substantially among infants, even within infants with variants in a single gene. Unusual EEG/aEEG findings, such as downward seizure patterns on aEEG, can be found. Neonatal seizures are exclusively of focal onset. An International League Against Epilepsy task force proposed that the seizure type is typically determined by the predominant clinical feature and is classified into motor or non‐motor presentations. Ictal EEG usually demonstrates a sudden, repetitive, evolving, and stereotyped activities with a minimum duration of 10 s. In epileptic spasms and myoclonic seizures, the cut‐off point of 10 s cannot be applied. One must always be aware of electro–clinical dissociation in neonates suspected to have seizures. Amplitude‐integrated EEG is also useful for the diagnosis and monitoring of neonatal epilepsies but aEEG cannot be recommended as the mainstay because of its relatively low sensitivity and specificity. At present, EEG findings are not pathognomonic, although some characteristic ictal or interictal EEG findings have been reported in several neonatal epilepsies. Deep learning will be expected to be introduced into EEG interpretation in near future. Objective EEG classification derived from deep learning may help to clarify EEG characteristics in some specific cases of neonatal epilepsy.     

小儿颞叶癫痫的手术治疗

采用颞前切除术治疗小儿颞叶癫痫１２例。其中９例病检有明显异常。无手术死亡。术后光明显神经功能障碍。经２～３年随访，痊愈４例，抽搐发作频度和严重程度减少６０％以上６例，无明显变化１例，失访１例。对用脑皮质电图作术中痫灶定位、手术适应证以及影响疗效的病理因素分析，认为小儿颞叶癫痫早期实施颞前切除术有良好临床疗效。