儿童药物难治性癫痫视频脑电图及影像学特征分析

Analysis of video electroencephalography and imaging characteristics in children with drug⁃refractory epilepsy

目的对比分析视频脑电图、MRI、PET显像在药物难治性癫痫患儿致痫灶检出率方面的差异。方法纳入2020年1月至2022年4月南京医科大学附属儿童医院收治的70例药物难治性癫痫患儿,分别予以24 h和2 h视频脑电图监测、MRI和PET/CT或PET/MRI,根据年龄(≥5或<5岁)分别采用瑞文标准推理测验(SPM)或0~6岁儿童智能发育筛查测验(DST)评估患儿智力。结果共70例患儿,24 h视频脑电图监测到44例(44次)癫痫发作,2 h视频脑电图监测到31例(39次)癫痫发作,两种监测方法差异具有统计学意义(χ^(2)=5.760,P=0.015)。视频脑电图、MRI、PET/CT或PET/MRI这3种方法诊断单部位/单侧异常、双侧异常、正常的一致性较差(κ=0.194,P=0.000),3种方法的诊断差异具有统计学意义(χ^(2)=33.068,P=0.001),其中,视频脑电图(χ^(2)=25.000,P=0.000)及PET/CT或PET/MRI(χ^(2)=11.764,P=0.002)的诊断能力高于MRI,PET/CT或PET/MRI的诊断能力亦高于视频脑电图(χ^(2)=8.048,P=0.014)。41例(58.57%)患儿智力落后,发病年龄≤2岁患儿智力落后比例高于发病年龄>2岁患儿(χ^(2)=6.193,P=0.013),脑电图背景异常患儿智力落后比例高于脑电图背景正常患儿(χ^(2)=4.868,P=0.027)。结论通过延长单次脑电图监测时间或增加脑电图监测次数可以提高痫样放电及临床癫痫发作检出率;PET/CT或PET/MRI、视频脑电图可以为MRI阴性患儿提供致痫灶的定位线索;发病年龄≤2岁、视频脑电图背景异常患儿的智力落后比例更高。

Objective To compare the detection rates of epileptogenic foci in drug⁃refractory epilepsy children using video electroencephalography(VEEG),MRI and PET.Methods The 24 h and 2 h VEEG,MRI and PET/CT or PET/MRI were conducted for 70 children with drug⁃refractory epilepsy in Children's Hospital of Nanjing Medical University from January 2020 to April 2022,and Raven's Standard Progressive Matrices(SPM)or Developmental Screening Test for Child under six(DST)based on their age(<5 or≥5 years old)were assessed for intelligence.Results Among 70 children,44 seizures were detected during 24 h VEEG,while 31 seizures were detected during 2 h VEEG,and there was statistically significant difference between the two methods(χ^(2)=5.760,P=0.015).The consistency of diagnosing single location/unilateral abnormalities,bilateral abnormalities,or normal results was poor among VEEG,MRI and PET/CT or PET/MRI(κ=0.194,P=0.000),and the difference among the three methods was statistically significant(χ^(2)=33.068,P=0.001).The VEEG(χ^(2)=25.000,P=0.000)and PET/CT or PET/MRI(χ^(2)=11.764,P=0.002)had higher diagnostic capabilities than MRI,and PET/CT or PET/MRI had higher diagnostic capability than VEEG(χ^(2)=8.048,P=0.014).There were 41 children(58.57%)showed mental retardation,among them children with onset age≤2 years had a higher rate compared to those with onset age>2 years(χ^(2)=6.193,P=0.013),and children with abnormal VEEG background had a higher rate compared to those with normal VEEG background(χ^(2)=4.868,P=0.027).Conclusions The detection rate of epileptiform discharges and clinical seizures can be increased by lengthening VEEG time at each time and increasing the number of times of VEEG.PET/CT or PET/MRI and VEEG can provide localization information of epileptic foci of children whose MRI results are negative.The mental retardation rate of children who have onset age≤2 years and of abnormal VEEG background is higher.