小儿癫痫治疗前后脑细胞葡萄糖代谢改变及临床价值

Glucose Metabolism Change and Clinical Value of Brain Cell before and after Therapy in Children Epilepsy

【目的】探讨小儿癫痫治疗前后脑细胞葡萄糖代谢改变与临床关系。【方法】对22例临床确诊为癫痫的患儿在治疗前后癫痫发作间期各查一次18F-FDG正电子发射计算机断层扫描(PET)脑显像,同时查EEG,PET与EEG检查相隔时间在两周以内。根据癫痫发作类型,常规使用一线抗癫痫药一种或两种,统计学采用符号秩和检验。【结果】治疗前后小儿癫痫发作间期18F-FDGPET显像有显著差异(P<0.005)。治疗前检查22例,有20例结果为脑葡萄糖低代谢异常,表现为弥漫性低代谢灶11例,单侧低代谢灶9例,正常2例,经过2年以上治疗,复查:无变化3例(其中原正常2例,异常1例),7例由原来异常转为正常(正常率59.9%),较前好转11例(好转率50%),加重2例。脑电图结果显示,治疗前后差异有统计学意义(P<0.005)。22例异常脑电图中,经治疗后,正常2例,好转18例,加重2例,治疗后PET与脑电图结果一致性比较显示,完全一致的改善11例,加重2例,正常2例。完全不一致的改善5例,正常2例。【结论】小儿癫痫脑细胞葡萄糖代谢变化与临床发作轻重有相关性。18F-FDGPET脑显像对预测癫痫愈后及评估脑损伤程度有重要临床价值。

[Objective]To investigate glucose metabolism and clinical value of brain cell before and after therapy in children epilepsy. [ Methods ] Twenty-two children with epilepsy were enroll in this study. ^18F-FDG （positron emission tomography） PET was performed during epilepsy breakout before and after therapy, meanwhile, EEG, PET and EEG were performed in two weeks. According to the type of epilepsy, one or two the first line medicines were used routinely. Signed rank sum test was applied. [Results]^18F-FDG PET imaging showed significant difference （P 〈 0.005）. Twenty cases showed low brain glucose metabolism, 11 were diffuse low metabolism loci, 9 were unilateral low metabolism loci, 2 were normal. After two years therapy, 3 cases were unchanged （2 were normal, 1 was abnormal）, 7 turned normal, normal rate was 59.9%, 11 were improved （the improved rate was 50%）, 2 were depravated. The electroencephalogram shored significant difference before and after therapy. Twenty-two cases showed abnormal electroencephalogram, 2 were normal, 18 were improved, 2 were depravated. Compared with PET and electroencephalogram after therapy, 11 improved coincidently, 2 depravated coincidently, 2 normal coincidently; 5 improved non-coincidently, 2 normal non-coincidently. [Conclusion ] Glucose metabolism change was associated with clinical breakout in children epilepsy. ^18F-FDG PET imaging has important clinical value in predicting prognosis and evaluating brain injury degree.