小儿癫(癎)持续状态36例临床分析

目的总结不同类型小儿癫持续状态(SE)的临床、脑电图特点及治疗反应,提高诊断及治疗水平。方法对36例临床发作及脑电图监测符合SE的患儿按发作类型进行分类,分析不同类型发作特点、病因、脑电图变化及治疗反应。结果症状性癫19例,隐源性癫14例,特发性癫3例。既往SE史14例,4例为首次发作。10例发病前智力、运动发育落后,5例发病后倒退。12例诊断为癫综合征。不同发作类型脑电图改变不同。非惊厥性癫持续状态(NCSE)患儿脑电图均表现为背景活动差,慢波多,其中4例伴有睡眠中癫性电持续状态。12例给予氯硝西泮,11例有效控制。结论不同类型的SE发作形式及脑电图表现不同,NCSE更为复杂,早期诊断和处理可提高生存率,减少神经后遗症的发生。

Clinical analysis of 36 cases of children with status epilepticus

Objective To summarize the clinical and EEG features and treatment of various types of status epilepticus (SE) in childhood in order to improve diagnosis and treatment level.Methods 36 SE patients were classified according to seizure types.The seizure types,disease cause,ECG and responses to treatment were analyzed.Results There were 19 patients with symptomatic epilepsy,14 with cryptogenic epilepsy,and 3 cases with idiopathic epilepsy.14 cases had history of SE and 4 had SE as the first epileptic seizure.10 patients had neurodevelopmental delayed prior to SE.5 cases were of regression and 12 were diagnosed as epileptic syndrome.The EEG was different according to different seizure types.Non-convulsive status epilepticus (NCSE) was characterized by weak background activity and multiple slow waves,in which 4 cases were complicated with ESES.Intravenous injection of clonizepame was efficient to control SE in 11 of 12 cases.Conclusion The clinical and EEG features are different according to various types of SE.Patients with NCSE have more diverse clinical features.Earlier diagnosis and treatment will improve survival rate and reduce nerve sequalae.