病毒性脑炎后癫痫的预后及其影响因素

目的探讨病毒性脑炎后癫痫(PEE)的预后及其影响因素。方法对50例病毒性脑炎伴PEE患者进行随访,以从未达到1年无发作为预后差评价指标,观察其预后。收集患者的临床资料,分析影响PEE预后差的危险因素。结果预后差组患者脑炎急性期有意识障碍及脑炎急性期有痫性发作、发作次数10次的比率显著高于预后好组(均P0.01)。年龄、性别、发作类型、脑炎急性期精神障碍、脑炎急性期神经系统缺损、脑炎急性期SE、CSF细胞数增多、EEG异常、头颅CT/MRI异常与预后差无相关性(均P0.05)。多因素Logistic回归分析显示,脑炎急性期意识障碍、脑炎急性期发作是PEE患者预后差的独立危险因素(OR=7.269,95%CI:1.22~43.35,P=0.029;OR=22.893,95%CI:4.02~130.43,P=0.000)。结论脑炎急性期意识障碍、脑炎急性期痫性发作是影响PEE预后差的独立危险因素。     

脑炎急性期癫痫发作进展为脑炎后癫痫的影响因素分析

目的 探讨脑炎急性期癫痫发作进展为脑炎后癫痫(Postencephalitic epilepsy,PE)的影响因素.方法 回顾性分析自2010年1月-2019年6月在云南省第一人民医院及昆明医科大学第一附属医院住院诊断自身免疫性脑炎(autoimmune encephalitis,AE)、病毒性脑炎急性期伴有癫痫发作并...     

病毒性脑炎与癫痫

病毒性脑炎常伴发癫痫。我们对近年来收治的病毒性脑炎作一回顾性研究,癫痫伴发率为62.69％,大多是大发作,且提示脑炎症状达高峰前出现癫痫发作的病例预后较好,反之则差;单纯疱疹病毒性脑炎较其他病毒性脑炎影像学检查异常率高,伴发癫痫率并不高。     

病毒性脑炎急性期继发癫痫的临床特点

目的:分析病毒性脑炎急性期继发癫痫的临床特点。方法:1982年4月5日～2003年12月15日连续住院的374例病毒性脑炎患者,采用统一的调查表,用Microsoft Access 2002建立数据库,共51个主项内容,部分主项有下属分项。分析患者癫痫发病情况,对比观察继发癫痫患者和无癫痫发作患者脑电图结果及预后情况。结果:374例中115例(30.8％)继发癫痫,其中全面发作72例(62.6％),单纯部分发作18例,复杂部分发作11例,部分继发全面14例。115例患者中23例(20.0％)出现癫痫持续状态,14例(12.2％)继发多系统损害,普通脑电图检查20例发现痫性放电,占17.4％。继发癫痫组额叶、颞叶损害共54例,占47.0％。继发癫痫组与无癫痫发作组比较,脑电图异常程度差异有显著意义(x2=23.6,P<0.01),大脑皮质损害发生率差异有显著意义(x2=85.53,P<0.001)。继发癫痫组住院天数26.1±23.6,无癫痫发作组住院天数17.9±5.0,二者比较差异有显著意义(t=5.33,P<0.001)。结论:急性病毒性脑炎后继发癫痫发作以全面发作最为常见,大脑皮质损害易于继发癫痫,癫痫发作影响病毒性脑炎患者病情恢复。     

病毒性脑炎后继发性癫痫的临床特点及药物疗效分析

最高.经正规抗癫痫治疗,仍有45%的患者为难治性癫痫.结论 脑炎是继发性癫痫的重要病因,其癫痫以颞叶癫痫最为常见,LEV疗效较好,患者长期预后不良.     

儿童重型病毒性脑炎预后的相关因素分析

目的回顾性分析儿童重型病毒性脑炎患者的临床资料,探讨影响其预后的相关因素。方法收集我院2011-03—2014-06儿科病房收治的112例重症病毒性脑炎患儿的临床资料,并在患儿出院后6个月时采用Liverpool预后评分量表评估其预后。根据预后情况将患儿分为痊愈组(n=46)和未愈组(n=62),分析患儿各项临床资料与预后的相关性。结果单因素分析发现,惊厥、偏瘫、合并多脏器损伤、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处对SVE预后均有影响(P0.05),为影响SVE预后的因素。患儿性别、年龄、有无发热、意识障碍、低钾血症、脑电图轻度异常、单侧幕上单一病灶对预后均无影响。多因素Logistic回归分析显示,惊厥、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处为SVE预后不良的高危因素。合并其他脏器损伤及偏瘫不是预后不良的高危因素。结论儿童SVE患者预后差,严重后遗症发生率及病死率高,严重威胁儿童的生存及生活质量,惊厥、低钠血症、高血糖、EEG中度异常、头颅MRI显示病灶累及幕下或超过2处等因素是儿童重症病毒性脑炎预后不良的高危因素。     

以癫痫为首发表现的病毒性脑炎57例临床分析

1 临床资料 1．1 一般资料 男26例，女31例，男女比例为1：1．2，年龄15—62岁，平均32岁。农村患者40例(70％)，城镇17例(30％)；夏、冬两季发病多见(69．6％)，起病至入院时间2—21d，平均18．8d．住院天数15～121d，平均28．2d。     

病毒性脑炎患儿恢复期癫痫的临床表现及高危因素分析

目的 探讨病毒性脑炎患儿恢复期SEP危险因素,并评估预后.方法 对133例病毒性脑炎出院患儿进行随访,恢复期SEP患儿21例作为试验组,比较2组患儿的临床表现、脑脊液、头颅影像学及脑电图特点,分析恢复期SEP高危因素.结果 试验组癫痫发作次数、惊厥持续时间、癫痫持续状态、脑脊液HSV-1 IgG检出率、EEG中重度异常及恢复时间均高于对照组,2组比较差异有统计学意义（P＜0.05或P＜0.01）.Logistic回归分析显示,癫痫发作次数、惊厥持续时间和EEG中重度异常及恢复时间为病毒性脑炎恢复期SEP的危险因素（P＜0.05）.结论 病毒性脑炎恢复期SEP的高危因素为急性期癫痫发作次数、惊厥持续时间和EEG中重度异常及恢复时间.     

病毒性脑炎并发症状性癫痫的综合护理

病毒性脑炎是指病毒侵犯中枢神经系统引起的感染性疾病,临床表现为头痛、恶心、呕吐、癫痫发作及意识障碍,严重者危及生命。病毒性脑炎并发癫痫通常表现为症状性癫痫。脑炎并发癫痫的患者临床表现更加复杂,对护理的要求更加严格,近年来,我院神经内科对病毒性脑炎并发症状性癫痫的患者实施综合性护理措施,取得较好效果,现报道如下。     

病毒性脑炎患者创伤后成长状况及影响因素分析

目的 总结病毒性脑炎患者创伤后成长现状,并筛查其影响因素.方法 以2017年7月至2019年7月在四川大学华西医院诊断与治疗的病毒性脑炎患者为调查对象,采用横断面调查方法,包括一般资料调查表、创伤后成长评定量表(PTGI)、家庭关怀度指数问卷(APGAR)以及心理弹性量表(CD-RISC),分析PTGI评分与年龄、AP...     

多发性硬化合并癫癎临床特点分析

目的探讨多发性硬化(multiplesclerosis,MS)患者中合并癫的情况。方法回顾1981—2004年北京协和医院收治的临床确诊和实验室支持确诊的MS患者119例,分析其中合并癫患者的临床特点。结果MS患者发生癫的患病率为5.0%±0.1%,明显高于普通人群患病率的0.5%～1.0%。但是起病年龄、额叶皮质下以及侧脑室旁病灶、年复发率及扩展功能障碍状态量表(EDSS)评分与多发性硬化患者是否出现癫无统计学明显相关。颞叶皮质下病灶与多发性硬化患者出现癫存在统计学相关(P=0.035)。结论MS患者较普通人群易患癫,其中存在颞叶皮质下病灶的MS患者更易出现癫。     

儿童枕叶癫痫68例随访研究

目的 探讨儿童枕叶癫痫的预后,方法 对１９８４年８月至１９９６年６月我院收治物６８例儿童枕叶癫痫患者进行了２－１２随访观察。结果 停止发作６５例（９６％）;停药后复发５例（８％）;脑电图异常随临床症状缓解而消失;病因明确者治疗较为困难。结论;枕叶癫痫患儿在药物控制发作１－２年后,脑电力产恢复正常者可以停药。     

Perisylvian vulnerability to postencephalitic epilepsy

ObjectivePostencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG).MethodsWe conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex.ResultsIndependent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a “patchwork” organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048).ConclusionsPostencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group. Significance: These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections.     

难治性癫痫早期预测因素的病例对照研究

目的 探索癫痫患者易演变为难治性癫痫（refractory epilepsy,RE）的早期预测因素,为临床尽早处理RE提供理论依据。方法 收集173例诊断明确、治疗合理的癫痫患者,分为药物难治性癫痫(drug non-responsive epilepsy,DNR-EP)组（106例）和药物有效性癫痫(drug-responsiveepilepsy,DR-EP)组（67例）。通过观察癫痫患者早期临床特点,采用多因素Logistic回归分析,探索癫痫患者易发展为RE的预测因素。结果 多因素Logistic回归分析显示：初次治疗前＞10次发作（OR =4.46,95％ CI 1.60～12.40,P=0.004）、早期伴智能障碍(OR=19.87,95％ CI 3.60～ 109.78,P=0.001)、治疗后脑电图仍有癫痫波样异常（OR=7.57,95％ CI 2.54～22.56,P＜0.01）是癫痫患者易发展为RE的预测因素;而初次使用抗癫痫药物(AEDs)治疗效果良好是RE的保护因素（OR=0.05,95％ CI 0.018 ～0.139,P＜0.01）。结论 初次治疗前发作次数多、早期伴智能障碍、治疗后脑电图仍有癫痫波样异常、初次AEDs治疗效果差的癫痫患者易发展为RE。     

癫(癎)患者先兆症状的研究

目的 探讨癫(癎)患者先兆症状的发生比例、临床表现,为正确诊断治疗癫(癎)提供依据.方法 回顾性研究1028例癫(癎)患者的临床资料,分析癫(癎)患者的先兆发生率、临床表现、脑电图和神经影像学结果.比较伴或不伴先兆的部分性发作癫(癎)患者的发病年龄、性别、脑电图、神经影像学的差异以及腹部先兆在颞叶内外侧癫(癎)出现比例的差异.结果 部分性癫(癎)725例,484例(66.8 % )出现先兆;全面性发作者303例,无一例患者出现先兆.64例患者出现2种或2种以上的先兆表现;14例出现持续性先兆的癫(癎)患者.1028例患者中脑电图异常547例(53.2 % ),影像学异常217例(21.1 % ).484例有先兆症状的患者中286例脑电图异常(59.1 % ),126例(26.0 % )影像学异常.伴或不伴先兆的部分性发作癫(癎)患者的首次发病年龄差异无统计学意义,腹部先兆在颞叶内外侧癫(癎)出现的比例差异有统计学意义(x2=170.877,P<0.01).结论 癫(癎)患者先兆症状多样,分析先兆症状对于癫(癎)分型、病灶定位以及合理治疗有指导意义.     

我国五省农村地区开展人群干预后癫(癎)治疗缺口的变化

目的 检验我国农村地区开展人群干预管理后癫癎治疗缺口的变化，为进一步推广癫癎社区控制经验提供依据。方法 2004年WHO合作项目结束后6个月，在开展项目的5个省农村示范地区，采用与基线调查完全相同的方法和标准随机抽样调查该地区癫癎流行病学状况，并对两次调查结果进行比较，以了解示范区干预前后癫癎患者的治疗情况以及治疗缺口的改变。结果 本次抽样调查5个农村人群共确诊癫癎患者320例，患病率为0．62％。其中活动性癫癎的患病率为0．45％。而基线调查时癫癎患病率和活动性癫癎的患病率分别为0．70％和0．46％。采用正规治疗的癫癎患者由2000年调查时的24．8％上升至39．1％。活动性癫癎的治疗缺口由基线调查时的62．6％下降为49．8％。结论 农村地区的癫癎患者经过WHO示范项目的干预和管理，接受正规或合理治疗的比例明显提高；活动性癫癎的治疗缺口显著下降。从而证明本方案采用的干预对策适用于我国农村地区，并有很好的推广价值。     

Postencephalitic epilepsy and drug‐resistant epilepsy after infectious and antibody‐associated encephalitis in childhood: Clinical and etiologic risk factors

To define the risk factors for postencephalitic epilepsy (PE) and drug‐resistant epilepsy (DRE) in childhood following infectious and autoimmune encephalitis, we included 147 acute encephalitis patients with a median follow‐up of 7.3 years (range 2–15.8 years). PE was defined as the use of antiepileptic drugs (AEDs) for ≥24 months, and DRE was defined as the persistence of seizures despite ≥2 appropriate AEDs at final follow‐up. PE and DRE were diagnosed in 31 (21%) and 15 (10%) of patients, respectively. The features during acute encephalitis predictive of DRE (presented as odds ratio [OR] with confidence intervals [CIs]) were status epilepticus (OR 10.8, CI 3.4–34.3), visual disturbance (6.4, 1.4–29.9), focal seizures (6.2, 1.9–20.6), magnetic resonance imaging (MRI) hippocampal/amygdala involvement (5.0, 1.7–15.4), intensive care admission (4.7, 1.4–15.4), use of >3 AEDs (4.5, 1.2–16.1), MRI gadolinium enhancement (4.1, 1.2–14.2), any seizure (3.9, 1.1–14.4), and electroencephalography (EEG) epileptiform discharges (3.9, 1.3–12.0). On multivariable regression analysis, only status epilepticus remained predictive of DRE in all models. DRE was common in herpes simplex virus (3/9, 33%) and unknown (8/40, 20%) encephalitis, but absent in acute disseminated encephalomyelitis (ADEM) (0/32, 0%), enterovirus (0/18), and anti‐N‐methyl‐d ‐aspartate receptor–NMDAR encephalitis (0/9). We have identified risk factors for DRE and demonstrated “high‐risk,” and “low‐risk” etiologies.     

癫痫患者事件相关电位P300及影响因素研究

目的探讨癫痫患者事件相关电位P300的特点及影响因素。方法选择经临床及脑电图确诊的癫痫患者53例和21例与其年龄、性别、文化程度相匹配的健康正常人为研究对象,进行事件相关电位P300测定,并使用Pearson相关分析对其可能的影响因素进行分析。结果癫痫患者和对照组P3波潜伏期分别为(361.32±26.76)ms与(311.27±18.43)ms,P3波波幅分别为(3.38±1.52)μV与(6.79±1.93)μV,差异均有统计学意义(P0.01)。相关分析显示,癫痫患者P3波潜伏期与病程、发作频率及每次发作持续时间呈正相关(P均0.05),与起病年龄呈负相关(P0.01);P3波的波幅与病程、发作频率、每次发作持续时间呈负相关(P均0.05),与起病年龄呈正相关(P0.01);而与患者的年龄、受教育年限、服用抗癫痫药物的种类无明显相关性。结论癫痫患者存在事件相关电位P300异常,其变化特点与癫痫患者的起病年龄、病程、发作频率及每次发作持续时间相关。     

Prognostic factors in neocortical epilepsy surgery: multivariate analysis

PURPOSE: Defining prognostic factors for neocortical epilepsy surgery is important for the identification of ideal candidates and for predicting the prognosis of individual patients. We use multivariate analysis to identify favorable prognostic factors for neocortical epilepsy surgery. METHODS: One hundred ninety-three neocortical epilepsy patients, including 91 without focal lesions on MRI, were included. Sixty-one had frontal lobe epilepsy (FLE), 80 had neocortical temporal lobe epilepsy (nTLE), 21 had parietal lobe epilepsy (PLE), and 22 had occipital lobe epilepsy (OLE). The primary outcome variable was patient status >or=2 years after surgery (i.e., seizure free or not). Clinical characteristics and the recent presurgical diagnostic modalities were considered as probable prognostic factors. Univariate and standard multiple logistic regression analyses were used to identify favorable prognostic factors. RESULTS: The seizure-free rate was 57.5%. By univariate analysis, a focal lesion on MRI, localized ictal onset on surface EEG, epilepsies other than FLE, localized hypometabolism on fluorodeoxyglucose-positron emission tomography (FDG-PET), and pathologies other than cortical dysplasia were significantly associated with a seizure-free outcome (p<0.05). Multivariate analysis revealed that a focal lesion on MRI (p=0.003), correct localization by FDG-PET (p=0.007), and localized ictal onset on EEG (p=0.01) were independent predictors of a good outcome. CONCLUSIONS: The presence of a focal lesion on MRI, correct localized hypometabolism on FDG-PET, or localized ictal rhythms on EEG were identified as predictors of a seizure-free outcome. Our results suggest that these findings allow the selection of better candidates for neocortical epilepsy surgery.