脑性瘫痪合并癫痫的临床特征

脑性瘫痪康复过程中,癫痫是经常遭遇的棘手问题。人口普查性流行病学调查以及医院或康复机构报道,脑瘫儿中癫痫患病率为8%~62%;癫痫可以发生在任何类型的脑瘫中,但以痉挛型四肢瘫和偏瘫最常见,低出生体重、新生儿发作、癫痫家族史、认知障碍、皮层损伤等因素明显增加癫痫的危险;脑瘫患儿癫痫半数以上1岁内发病,痉挛型四肢瘫癫痫发病年龄早于其他类型脑瘫;癫痫类型以部分性最常见,其次是婴儿痉挛和Lennox-Gastaut综合征;脑瘫患儿的癫痫往往预后差,半数属于难治性癫痫,需要多药治疗,发作控制率37%~65·2%。

Clinical Aspects of Epilepsy in Children with Cerebral Palsy: a Review

The occurrence of epilepstic seizures in patients with cerebral palsy (CP) remains a serious event and is very disruptive for children who already suffered from orther disabilties. Data from population-based studies or neurodevelopmental clinic studies showed that 8%~62% of patients with CP suffer from epilepsy. The incidence is highest in spastic tetraplegia and hemiplegia. Half of the patients were onset within the first year of age. Children with tetraplegia CP tended to have an earlier onset of epilepsy than chlidren with other CP types. Partial seizures were the most common seizure types, followed by infantile spasms and Lennox-Gastaut syndrome. Low birth weight, neonatal seizures, family history of epilepsy, lower intelligence and grey matter damage were found to be related to significantly increased risk of epilepsy. Epilepsy in children wih CP usually had poor outcome, half of them were intractable and needed polytherapy. Only 37%~65.2% of patients became seizure-free.