自身免疫性脑炎患儿癫痫发作特点及抗癫痫药物治疗分析

Characteristics of epileptic seizures in children with autoimmune encephalitis and antiepileptic drug therapy

目的探讨自身免疫性脑炎(AE)患儿癫痫发作特点及抗癫痫药物的治疗效果。方法收集2014年1月-2018年12月在本院神经内科住院的有癫痫发作且诊断为自身免疫性脑炎患儿62例,其中男34例,女28例,就诊年龄为6个月~13岁6个月,平均年龄7岁8个月。总结分析患儿癫痫发作特点、头部MRI、视频脑电图、血及脑脊液抗神经元抗体检测、使用的免疫疗法及抗癫痫药物类型、治疗结果等。结果所有患儿中有34例(54.84%)患儿以癫痫发作为首发症状;13例患儿为全面性强直阵挛发作,27例为局灶性发作,18例为局灶性进展为双侧强直-阵挛,2例为局灶起源自主神经发作,1例为失神发作,1例为痉挛发作。62例患儿中局灶性起源发作共47例(75.81)%。有24例(38.71%)患儿有癫痫发作持续状态,16例(25.81%)有频繁的簇状发作。所有患儿明确诊断后均给予了免疫治疗(免疫球蛋白联合激素),23例单用免疫治疗后癫痫发作控制。39例患儿联合了口服抗癫痫药物治疗,其中21例用了1种抗癫痫药物,13例用了2种抗癫痫药物,5例用了3种抗癫痫药物。首选抗癫痫药物主要为奥卡西平。结论癫痫发作是AE最突出的症状,多表现为部分性发作并快速进展为癫痫持续状态(SE)或严重的簇状发作。对于有癫痫发作的AE患者,主要依靠免疫治疗,并建议依据癫痫发作的类型,合理选用抗癫痫药物联合治疗。

Objective To determine the characteristics of epileptic seizures in children with autoimmune encephalitis(AE)and the therapeutic effect of antiepileptic drugs.Methods Totally 62 children with AE with seizures were analyzed from January 2014 to December 2018 in our hospital(34 males and 28 females,aged from 6 months to 13 years and 6 months).The average age was 7 years and 8 months.All data were analyzed,including seizure characteristics,head MRI,video EEG,anti-neuron antibodies of blood and cerebrospinal fluid,immunotherapy and antiepileptic drugs,treatment results,etc.Results Among these 62 children,34(54.84%)had epilepsis as the first symptom.As to the types of seizure in the 62 children with AE,13 had generalized tonic-clonic seizures,27 had partial seizures,18 focal to bilateral tonic-clonic seizures,autonomic seizures of local origin in 2,1 absence seizure and 1 convulsive seizure.All children were given immunotherapy(immunoglobulin combined with glucocorticoid)and 23 epileptic children were well controlled with the immunotherapy alone.Oral antiepileptic drugs were combined in use if necessary.Oxcarbazepine was the first choice in antiepileptic drugs.Totally 39 children were given combined use of oral antiepileptic drugs,of which 21 had 1 antiepileptic drug,13 had 2 antiepileptic drugs,and 5 had 3 antiepileptic drugs.Conclusion Epileptic seizures are the most prominent symptoms of AE,mostly manifested as focal seizures and rapidly developing into status epilepticus or severe cluster attacks.For child AE patients with epileptic seizures,immunotherapy combined with antiepileptic drugs is suggested.According to the different types of seizures,combinations of antiepileptic drugs are selected to effectively control seizures.