老年性癫痫的临床分析

The clinical analysis of senile epilepsy

目的 探讨老年性癫痫的发作类型、发病原因、脑电图(EEG)检查、治疗及预后.方法 回顾性分析2012年1月-2015年9月在重庆医科大学附属第二医院住院的92例老年性癫痫患者的临床资料.结果 单纯部分性发作15例(16.3%),复杂部分性发作22例(23.9%),全身强直-阵挛性发作40例(43.5%),部分性继发全身性发作4例(4.3%),两种及两种以上发作形式11例(12.0%).常见病因包括脑血管疾病(57.6%)、颅内肿瘤(10.9%)、脑退行性病变(7.6%)等.常规EEG异常率87.1%,仅22.6%有典型癫痫样放电;动态EEG异常率91.7%,70.8%有典型癫痫样放电.82例(89.1%)给予抗癫痫药物(AEDs)治疗,其中69例长期用药,单药治疗者57例(82.6%).AEDs治疗后55例(67.1%)有效,11例(13.4%)无效,16例(19.5%)死亡;年龄与病死率呈正相关(Spearman相关系数0.314,P=0.002).9例(10.9%)出现不良反应,多数表现为嗜睡.结论 老年性癫痫绝大多数为症状性癫痫,主要病因为脑血管疾病,发作形式主要以全身强直-阵挛性发作为主.老年性癫痫患者常规EEG检查癫痫放电率低,推荐应用动态EEG或VEEG检查.多数老年性癫痫患者药物治疗效果良好,少数可出现程度较轻的不良反应.

Objective To investigate the classification of seizures,etiology,EEG exanination,treatment and prognosis of senile epilepsy.Methods The clinical data of 92 senile epileptsy patients in the Second Afiliated Hospital Of Chongqing Medical University from January 2012 to September 2015 were retrospectively analyzed.Results From the selected sample,15 cases suffered from SPS(16.3%),22 cases suffered from CPS(23.9%),,40 cases suffered from GTCS(43.5%),4 cases suffered from partial seizures with secondary generalization(4.3%),11 cases suffered from both partial seizures and generalized seizures(12.0%).The common causes include cerebrovascular disease(57.6%),intracranial tumors(10.9%),degenerative brain diseases(7.6%)and so on.The abnormal ratio of REEG and AEEG was 87.1%and 91.7%respectively.The ratio of typical epileptiform activity in the REEG and AEEG was 22.6%and 70.8%respectively.82 cases(89.1%)were treated with AED,but only 69 cases had been taking orally AED among the patients treated with AED.57 cases(82.6%)were on monotherapy.55 cascs(67.1%)were contolled effectively with drug treatment,11 cases(13.4%)were ineffective and 16 patients(19.5%)died.Advanced age was the important cause of death.Age was positively correlated with the fatality rate.9 cases(10.9%)appeared side ffect,the frequency of slepiness was the highest among all the adverse reactions.Conclusion The majority of senile epilepsy suffer from symptomatic epilepsy.The main cause is cerebrovascular disease,the generalized tonic-clonic seizures constituted a high proprotion in the sample.The ratio of typical epileptic discharge in the REEG was low from senile patients with epilepsy,we reconmend the AEEG examination in the senile patients suspected with epilepsy.AED has excellent therapeutic effects in senile epileptics,and a few patients appeared light adverse reactions.