儿童睡眠癫痫电持续状态的临床与脑电图变化

目的探讨儿童睡眠癫痫电持续状态(ESES)临床和脑电图变化。方法收集2009年6月至2011年8月本院诊断ESES的患儿31例,分析其临床资料。结果 21例患儿单药控制临床发作疗效欠佳,丙戊酸钠联合用药治疗反应良好,首发年龄越小,则发作和EEG异常的持续时间越长。药物及激素治疗效果越差。13例(42%)予甲泼龙冲击治疗,9例(69%)在甲泼尼龙冲击疗程结束后癫痫发作控制,或发作减少50%以上,3例(23%)发作无改善。5例(38%)神经心理损伤及运动倒退情况明显好转,2例(15%)好转半年后再次出现神经心理倒退,6例(46%)较治疗前无变化。结论甲泼尼龙对ESES临床治疗疗效不一。对于消除中央区-颞区电持续续状态效果明显,但对特发性枕区癫痫伴ESES现象及年龄<2岁癫痫患儿疗效欠佳。

The study of clinical characteristics and ECG changes in children with electrical status epilepticus in sleep

Objective To evaluate clinical manifestations,EEG characteristics,treatment response and prognosis of children with electrical status epilepticus in sleep(ESES).Methods To collect clinical date of patient with ESES phenomenon found during EEG monitoring,from June 2009 August to 2011,31 cases were analysed.Results 21 cases with single-agent had poor efficacy in control of clinical seizures,valproate combination therapy responded well,starting younger,the onset and duration of EEG abnormalities longer,the worse effects of drugs and hormone therapy,13 patients(42%) with methylprednisolone shock therapy,9 patients had the control of epileptic seizures after treatment,or seizures reduced by 50%,and 3 cases without improvement,5 cases of nerve injury and sports psychology back marked improved,2 cases had neuropsychological back again after six months,6 patients without change.Conclusion Clinical efficacy of methylprednisolone on the ESES varied,It was obvious for the elimination of central-temporal electrical status epilepticus,but poor efficacy for idiopathic occipital epilepsy with ESES phenomenon and age < 2 years of poor efficacy in children with epilepsy.