儿童枕叶癫癎的临床及脑电图特征

目的总结儿童枕叶癫癎(COE)的临床和脑电图(EEG)特征及预后。方法对43例COE患儿的临床资料进行回顾性分析。结果起病年龄5个月-13岁;癫癎发作表现为眼球偏转20例,呕吐15例,头偏转14例,头痛10例,口咽部或手自动症9例,黑朦8例,视幻觉7例,眼睑扑动7例,眼球阵挛3例;继发半侧阵挛11例,继发全身性发作18例。头颅影像学异常15例。有明确脑损伤病史和／或头颅影像学检查证实枕叶有病变者23例,诊断为症状性COE,其余20例符合特发性COE。发作间期EEG有癎样放电41例,其中位于枕区19例,枕、后颞区15例,少数可在枕区以外。15例记录到发作期EEG。40例随访1～9 a,其中特发性19例,对抗癫癎药物疗效好,17例无复发,其中11例已停药。症状性COE对抗癫癎药物疗效欠佳,发作完全控制仅8例。结论COE发作的临床特点为跟球偏转、视觉症状、呕吐、头痛、眼睑扑动;发作间期EEG放电主要在枕区或枕、后颞区,少数可在枕区以外;特发性COE预后优于症状性COE。

Electroclinical spectnun of childhood occipital epilepsy

Objectives To describe the electroclinical features and outcome of childhood occipital epilepsy (COE). Methods Clinical data of 43 children with occipital epilepsy were retrospectively reviewed. Results The onset ages of seizure were from 5 months to 13 years. Seizure manifestations were various including eye deviation (20), ictal vomiting (15), head deviation (14), ictal headache (10), automatisms (9), visual loss (8), visual hallucination (7), eyelid twitching (7), nystagmus (3), secondary hemiconvulsions (11) and generalized convulsions ( 18) . Abnormal head magnetic resonance image findings were seen in 15 cases. Twenty-three (23) out of 43 patients diagnosed as symptomatic COE had a history of brain damage and/or abnormalities of occipital lobe on neural imaging examination. The other 20 of the 43 patients were diagnosed as idiopathic COE. The interictal EEG discharges were seen in 41 cases, of which 19 had epileptiform discharges localized in bilateral or unilateral occipital lobe, and 15 in occipital and posterior temporal areas. EEG was recorded in 15 patients during seizure attack. Forty (40) patients were followed up 1 to 9 years. Seventeen (17) out of 19 idiopathic COE patients were seizure free, while 8 out of 21 symptomatic COE patients were seizure free. Conclusion The clinical seizure characteristics of COE were eye deviation, ictal vomiting, ictal headache, visual symptoms, eyelid twitching. Seizures evolved to hemiconvulsions or generalized convulsions in some patients. Though the epileptiform discharges predominantly localized in the occipital region, there were also discharges in other locations alone or synchronously with occipital discharges. Prognosis in idiopathic COE was better than that of symptomatic COE.