婴儿良性部分性癫痫35例临床分析

目的:研究婴儿良性部分性癫痫的临床特点及治疗反应,探讨早期诊断方法。方法:对生后24个月内起病、排除热性惊厥、症状性癫痫、发育异常的婴儿惊厥进行临床及脑电观察,并随访治疗和预后。结果:35例患者7例惊厥伴轻度胃肠炎,5例有良性婴儿惊厥家族史,29例有丛集性发作,14例VEEG监测证实分别为起源于颞、枕、额、顶区的部分性发作。发作间期脑电图无异常。所有病例均接受抗癫痫单药治疗,5例失访。30例平均用药时间8.1个月,29例于服药6个月内发作消失,停药后3例复发,随访期内未见2岁后再复发者,21例随访至2岁以上确诊为婴儿良性部分性癫痫。结论:起病早期有以下特点应考虑婴儿良性部分性癫痫可能:①首发年龄1岁以内,不超过2岁;②复杂部分性发作或复杂部分性发作伴泛化;③呈丛集性发作,但无癫痫持续状态;④无神经系统基础病,发作无明显诱因;⑤起病前精神运动发育正常,神经影像检查正常;⑥可有婴儿良性惊厥家族史;⑦发作间期脑电图无异常,发作期有痫样放电。

Clinical Study on 35 Infants with Benign InfantileEpilepsy

Objective:To investigate clinical characteristics and therapeutic response of benign infantile epilepsy and to explore the early diagnostic methods.Methods: Clinical observation and Video-EEG monitoring were carried out in babies with convulsions within 24 months of age.In these children,febrile convulsion,symptomatic epilepsies and developmental abnormalities were excluded,and the therapeutic effect and long-term outcome were followed up.Results:Seven of 35 babies had mild gastroenteritis during the onset of convulsions. Five babies had familial history of benign infantile convulsions,29 patients had crowd together seizures.Video-EEG monitoring confirmed seizures originating from temporal,occipital,frontal or parietal in 14 patients with partial Seizures.Interictal EEG was not abnormal.All patients were treated with single antiepileptic drugs,5 cases lost follow-up.Thirty cases received mean treatment course of 8.1 months,29 were seizure free within six month.Three cases relapsed after treatment.All cases did not relapse after two years of age,21 were diagnosed clearly benign infantile epilepsy who were followed up after two years of age.Conclusion:Benign infantile epilepsy should be considered when the following characteristics occur in early stage of the disease:(1)convulsions occurring before one year of age and not later than two years of age;(2) complex partial seizures or complex partial seizures with generalized seizures;(3) crowd together seizures,but no status epilepticus;(4) no basic disease of nerves system ,no obvious evoked factors;(5) normal psychomotor development before convulsion occurs,normal neuroimaging;(6)with or without familial history of benign infantile convulsion;(7) not abnormal EEG during sleep,had epileptic discharge in convulsion occurs.