伴高热惊厥史的儿童癫痌病例分析

分析伴高热惊厥史的癫痌患儿的临床特点，探讨高热惊厥脑损伤及其与颞叶癫痌的关系。 方法对1996～1999年本院儿科神经病房480例住院癫痌患儿进行回顾性分析，包括首发年龄、家族史、持续时 间、癫痌发作类型、神经影像学及脑电图改变等。结果115例(23.9％)患儿有前期高热惊厥史。伴高热惊厥史 的患儿癫痌发作早且易于出现癫痌持续状态。与无高热惊厥史的患儿相比，伴高热惊厥史的患儿强直-阵挛发作 较多，复杂部分性发作较少。408例患儿曾行影像学检查，4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史 的癫痌患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫痌患儿。有6.08％(7/115)伴高热惊厥史的癫 痌惠儿和6.84％(25/365)无高热惊厥史的癫痌患儿脑电图表现为单纯颞叶异常放电，二组相比无明显差异。结论 在癫痌患儿中，高热惊厥可能伴有脑损伤，且可能与后期的癫痌发生有关，伴高热惊厥史者不一定发展为颞叶癫痌。

Analysis of children epilepsy with history of febrile convulsion

Objective To investigate clinical characteristics in children with epilepsy who have a history of preceding febrile seizures,the possible brain damage with febrile seizures,and the relationship of prior febrile seizures to temporal lobe epilepsy.Methods 480 children who were admitted to our pediatric neurological unit from 1996 to 1999 were studied by retrospective analysis including age at onset,family history,status epilepticus and seizure type,neuroimaging and EEG. Results 115(23 9%) cases had preceding history of febrile seizures.Children with febrile seizures were younger at onset of epilepsy,and were more likely to develop status epilepticus.Compared with children without febrile seizures,children with prior febrile seizures had more tonic clonic onset,fewer complex partial seizures.Imaging studies were performed in 408 children(85%),of the 4 children whose imaging studies demonstrated hippocampal atrophy,none had a history of febrile seizures.Interictal EEG focal epileptic discharges were fewer in epileptic children with prior febrile seizures.Epileptic discharges were temporal focus in 6 08%(7/115) children with prior febrile seizures and 6 84%(25/365) children without prior febrile seizures,no significant differences were seen between two groups. Conclusions In epileptic children,preceding febrile seizures might cause brain damage and may be related to later epilepsy.But in children with prior febrile seizures,their epilepsies are not necessarily be temporal lobe epilepsy.