儿童头痛性癫痫诊断问题的探讨

目的探讨头痛性癫痫的诊断及与偏头痛的鉴别诊断。方法分析由院外诊断为头痛性癫痫的１０２例患者的临床资料，详细询问病史，进行仔细的体格检查，复查ＥＥＧ１～３次后，重新确定诊断，实施治疗并进行临床随访。结果１０２例患者中，６８例为偏头痛，３４例为神经性头痛。复查ＥＥＧ结果显示大部分在正常范围，部分异常ＥＥＧ中以弥散性慢波增多为主，仅有３例ＥＥＧ显示有散在癫痫样波，但临床表现却符合典型偏头痛的诊断。结论头痛性癫痫临床少见，单纯以头痛诊断为癫痫是不可靠的，必须依靠临床表现、ＥＥＧ检查结果综合判断，并和偏头痛进行鉴别。以头痛为主诉的儿童不应轻易诊断为癫痫。

Study on the diagnosis of childhood headache epilepsy

Objective To investigate the diagnosis of headache epilepsy and differential diagnosis of the disease from migraine. Methods Clinical data of 102 patients with headache epilepsy prorided by other hospitals were analysed. The case history was inquired, physical examination made, and electroencephalography reexamined. After the diagnosis was made, the patients were treated and followed up. Results Magraine was found in 68 of the 102 patients, and nevous headache in 34. In most patients EEG was normal. The increase in diffused inactive echoes, and only 3 of the above abnormal EEG showed scattered epileptic waves, but the manifestations were in accord with the diagnosis of typical migraine. Conclusions Headache epilepsia is rare clinical. It is not reliable to diagnose epilepsia with manifestation of headache as headache epilepsia. The diagnosis should be dependant on the clinical manifestation, EEG findings, and this disease should be differentiated from migraine.