儿童良性癫伴中央颞区棘波患儿临床表现及脑电图特点

Clinical characteristics and electroencephalographyic features of benign childhood epilepsy complicated with centrotemporal spikes in childre.

目的探讨儿童良性癫痫伴中央颞区棘波（BECT）的临床表现和脑电图变化的特点。方法对2002—07—2004—09在北京儿童医院神经科门诊治疗的59例BECT患儿的临床资料进行分析，诊断明确后予抗癫痫药物治疗，其中28例患儿于治疗后3、6个月复查脑电图，比较治疗前与治疗后脑电图异常放电部位、放电频度及波形的动态变化。结果发病高峰年龄为7～9岁，癫痫发作类型为部分运动性发作（27／59例）、部分泛化全身性发作（48／59例）及两种发作类型均有（16／59例）。发作与睡眠密切相关，多在刚入睡不久（46／59例）或晨起欲醒时（25／59例）。临床主要表现为一侧口角歪斜或抽动（54．2％）、流涎（40．7％）和言语不能（27．1％），夜间易泛化为全身性发作。发作间期脑电图背景活动正常，在中央和（或）中颞区可见高幅棘波或尖波。治疗前与治疗后多数（21／28例）脑电图异常放电是变化的，或在中央和中颞区间移动，或由一侧转到另一侧，治疗3个月时7例（7／28）例异常放电消失，治疗6个月时其中5／7例异常放电又出现。2例监测到临床发作，脑电图为起源于发作对侧中央中颞的节律性低幅棘波、尖波，逐渐波及同侧甚至对侧导联。结论BECT具有与睡眠密切相关的两种发作类型，以部分泛化全身性发作居多（48／59例）。脑电图特征对该病诊断有重要价值，中央中颞区棘波具有变化性、游走性甚至一过性消失的特点，

Objective This study aimed to recognize the clinical characteristics and electroencephalographic features of BECT. Methods The clinical data of 59 patients with BECT were analyzed who were treated from July 2002 to September 2004. and the patients were treated with anticonvulsants after definite diagnosis. Among the 59 cases ,28 were re-examined on EEG three and six months after treatment, and the location, the frequency and the morphology of epileptic discharges were compared before and after treatment. Results Of the 59 patients, age at onset of BECT was of a peak at 7 - 9 years. The seizure types were partial seizure（ 27/59 cases） and generalized partial seizure（ 48/59 cases） ;16/59 patients had these two seizure types. The seizure was associated with sleep closely, usually shortly after falling asleep（46/59 cases ） or before awakening（ 25/59 cases ）. All patients presented unilateral convulsions involving mouth （ 54. 2% ）, drooling （40. 7%） and speech arrest（27.1% ） ,and they tended to generalize tonic-clonic seizures. The background activity of EEG was normal. The location of epileptic discharges was in centrotemporal area,midtemporal area and central area. During treatment, the spikes （ 21/28 cases ） tended to spread from side to side. The focal discharges （ 7/28 cases ） disappeared three months after treatment, but 5/7 patients were found again six months after treatment. Two patients had convulsion during video-EEG monitoring;the ictal EEG was frequent rhythmic low-voltage spikes originating from the centrotemporal region in hemisphere,then spreading to the entire ipsilateral hemisphere and finally to the contralateral side. Conclusion BECT has two seizure types connected with sleep closely,and the type of generalized partial seizure is more common. EEG has important diagnostic value in diagnosing BECT. The centrotemporal spikes tend to vary,shift or disappear sometimes.