儿童癫癎的诊断和治疗

目的研究癫癎诊断和治疗的现状。方法采用回顾性分析方法,对5年间450例门诊和住院的癫癎患儿资料进行发作类型与年龄的关系、脑电图及药物的疗效分析。结果450例中全面性发作63.1%(284例),其中大发作33.3%(150例);局限性发作16.7%(75例);其他类型发作20.2%(91例)。本组68.2%为6岁以下儿童,其中<3岁占73%。1岁以内发作类型最常见为婴儿痉挛(WS),占该年龄组的41.1%(46/112例)。失神发作见于学龄期儿童,占本组病例的2.4%,Lennox-Gastaut综合征在9岁前各年龄组均可发生,热性惊厥转变为大发作见于学龄期儿童。癫癎发作的诱因主要为发热,有家族史占各种诱因的4.7%。癫癎的病程最长13年。脑电图(EEG)异常率达74.9%,其中普通EEG示癎样放电为50.5%,加做video-EEG或24h动态EEG后阳性率达62.8%。65.7%无影像学异常改变。120例(26.7%)诊断后未治疗或服药后未复诊。330例中单药治疗组总疗效76.5%,联合用药组为55.6%,两者之间疗效存在显著差异(P<0.05),而单药治疗组与WS组疗效比较无显著性差异(P>0.05)。结论癫癎治疗以单药治疗为主,但WS联合用药效果较佳。癫癎治疗滥用药现象较严重,有待规范化治疗。

Clinical Diagnosis and Therapy of Epilepsy in Children

Objective To investigate the clinical status of the diagnosis and therapy of epilepsy in children. Method The data of 450 children with epilepsy in outpatient and inpatient department were retrospectively studied. Results In 450 epileptic cases,generalised seizures occurred in 284 cases (63.1%) ,in which tonic- clonic seizures occurred in 150 cases (33.3% ), partial seizures occur red in 75 cases (16. 7%);other types occurred in glcases (20. 2%). In total cases, children under 6 years accounted for 68. 2%, and<3 years for 73.6% . West syndrome(WS) mostly often occurred in babies between 0 and 1 year.accouted for 41.1% (46/112 cases). Absence epilepsy and febrile convusions evolving to generalized seizures occurred usually in school-age children, for2.4% and 3.1% respectively. Lennox - Gastaut syndrome was found in children under 9 years old. The inducing factor was fever ,4.7% cases had family history,The longest course of epilepsy was 13 years. Seventy four point nine percent showed abnormal EEG patterns, but epileti-form discharge was only 50.5% with common EEG. The abnormal ratio may be enhanced by 12.8% after adding video- EEG or 24 hours dynamic-EEG, 65. 7% had no abnormal CT or MRI change.The effective rates with one drug and more drugs were 76.5% and 55.6% respectively (P<0.05),but it had no significant difference (P>0.05) when the results of therapy were compared between the group treated by one drug and WS group. Conclusions The treatment of epilepsy is more effective with one drug than more drugs, but drug combination is more effective in WS than in other cases. The abuse of drugs is more severe in therapy of epilepsy, which shall be normalized.