儿童良性枕叶癫痫47例临床及脑电图分析

The analysis of clinical and electroencephalographic features in patients with benign epilespy of children with occipital paroxysms

目的：探讨儿童良性枕叶癫痫（BECOP）的临床表现及脑电图（EEG）特点，以期提高对此病的认识水平。方法：对2005年1月至2010年12月南京军区福州总医院癫痫中心收治的47例BE—COP患儿资料进行回顾性分析，将其分为早发性儿童良性枕叶癫痫（EBOS）组和晚发性儿童良性枕叶癫痫（LOS）组，对比研究两组的起病年龄、发作频率、持续时间及发作时间分布、临床特征、EEG改变及对药物治疗的反应。结果：EBOS组平均起病年龄为（5．2±2．8）岁，以自主神经症状发作为主，发作频率低而持续时间长，有夜间发作倾向；LOS组平均起病年龄为（10．3±3．2）岁，发作频率高而持续时间短，视觉症状常见，可出现视幻觉，易继发全身性强直阵挛发作，以白天发作为主。两组患儿头眼偏转发作、跌倒发作及发作后头痛、呕吐症状比较差异无显著意义。两组发作间期EEG大部分显示枕区为主的棘、尖慢波，但EBOS组较局限且波形典型，LSO组易于泛化。发作期显示枕区或额区为主或全脑节律性棘慢波活动。EBOS对抗癫痫药物反应好，单药治疗23例（92％）可完全控制发作；LOS对抗癫痫药物治疗反应稍差，14例（63．6％）可控制发作，5例好转，3例无效。结论：EBOS和LOS在起病年龄、发作频率及持续时间、发作时间分布、自主神经系统症状、视觉症状、EEG放电特点、抗癫痫药物治疗反应等方面均有差别，综合分析可作出鉴别诊断。

Objective：To summarize the clinicai characteristics and electroencephalographic features in patients with benign epilespy of children with occipital paroxysms （BECOP） and to gain better understanding of it. Methods： The clinical data of 47 patients with BECOP referred and followed up in Epilepsy Center of Fuzhou General Hospital between January 2005 and December 2010 were analysed, to illustrate the difference between early onset benign occipital seizure susceptibility syndrome （EBOS） and late onset children idiopathic occipital seizures （LOS） with regard.to the age of onset, the frequency and duration of seizures, symptoms and signs, EEG changes and therapeutic responses to AEDs. Results.. The mean age of onset of patients with EBOS [（5.2±2.8） years] was significantly younger than that of patients with LOS[（10.3±3.2） years]. Compared with LOS patients, EBOS patients had remarkable paroxysmal autonomic symptoms, less frequent seizures, longer seizure duration and more nocturnal sei zures. LOS patients had more visual symptoms including hallucinations and tended to secondary general ized tonic-clonic seizures that occurred mostly in daytime. The interictal EEG showed occipital or occipi tal predominance of spikeand sharp-slow waves, more typical and limited in EBOS patients than those in LOS ones. Ictal EEG showed the occipital or frontal predominance and generalized rhythmic spike wave complex. EBOS was controlled well by AED monotherapy, with 23 （92%） seizure free; Seizures ceased in 14（63.6%） cases of LOS, and were partially controlled or unchanged in 5 and 3 cases respectively. Conclusion： It is essential to distinguish EBOS from LOS by comprehensive analysis of their features with regard to the age of onset, the frequency and duration of seizures, paroxysmal autonomic symptoms, visual symptoms, EEG changes and therapueutic responses to AEDs.