早产儿惊厥

Seizures in preterm infants

生后前几周,早产儿脑极易受损且惊厥发生率极高.但许多早产儿惊厥发作并没有典型的临床表现,只能依靠脑电图(EEG)为临床合理诊疗提供主要依据,而早产儿EEG背景活动和模式受胎龄影响较大.早产儿生后出现的某些阵发性活动主要与脑成熟度相关,而不是癫痫性放电.这些不成熟的一过性尖波与病理性尖波或棘波在波形上没有明确的区分标准.而且,相较于足月儿,早产儿惊厥发作的波幅及频率更低.该文综述了目前早产儿惊厥发病率和典型EEG发作模式,以及惊厥发作本身对早产儿长期预后的影响,并阐述了EEG监测伪差的构成.

Preterm newborn infants are at risk for cerebral dysfunction and susceptible to seizures in the first weeks of life.Because of less reliable clinical signs,many seizures of preterm neonates are detectable only on electroencephalogram(EEG).Understanding EEG background patterns and features in these preterm infants is vital to provide appropriate treatment.As EEG background activities and patterns significantly depend on gestational age,some physiologic preterm EEG patterns,such as rhythmic temporal theta activity or delta brushes,may be sharply contoured and appear similar to epileptic EEG patterns later in life in preterm infants.Moreover,compared with full-term neonates,ictal patterns in preterm infants are of lower voltage and frequency.This article reviews current incidence of seizures in preterm infants and their typical ictal EEG patterns.It also discusses the influence of seizures on long-term outcome of preterm infants and distinguishes the pitfalls of EEG analysis.