儿童病毒性脑炎继发癫癎危险因素及预后分析

Analysis of Risk Factors and Prognosis in Children Secondary Epilepsy after Viral Encephalitis

目的:探讨儿童病毒性脑炎继发癫癎危险因素,并评估预后。方法:对病毒性脑炎伴有惊厥发作的342例患儿进行随访分析,对继发癫癎患儿给予抗癫癎治疗观察疗效。结果:342例病毒性脑炎恢复期继发癫癎30例,占8.9%,继发癫癎组惊厥次数、惊厥持续时间、意识障碍持续时间、EEG重度异常率、EEG出现癫癎波百分数、EEG恢复时间及MRI异常率均高于非继发癫癎组,2组比较差异有统计学意义(P<0.05或P<0.01)。Logistic回归分析显示惊厥持续时间及EEG恢复时间为病毒性脑炎继发癫癎的危险因素(P<0.05)。年龄、发热时间、肢体瘫痪出现率、头CT异常率、脑脊液异常率2组比较差异无统计学意义(P>0.05)。30例继发癫癎的患儿应用抗癫癎药物治疗,总有效率80%。结论:病毒性脑炎恢复期继发癫癎的危险因素为惊厥持续时间长及EEG恢复时间慢。积极防治惊厥可以减少病毒性脑炎继发癫癎的发生。

Objective： To investigate the risk factors and prognosis of secondary epilepsy after viral encephalitis in children. Methods： Three hundred and forty-two medical records of viral encephalitis cases with seizures from January 2000 to December 2004 were reviewed and the anti-epilepsy treatment was observed in secondary epilepsy children. Results： Thirty of 342 cases （8.9%） were secondary epilepsy after viral encephalitis. Frequency of seizures, duration of seizures, time of impaired consciousness, serious abnormal EEG, percentage of electroencephalogram （EEG） discharge, abnormal magnetic resonance imaging and time of recovery to EEG of secondary epilepsy group were significantly higher than those in control group. There were significant differences between two groups （P 〈 0.05）. Multiplicity logistic regression model analysis showed time of recovery to EEG and duration of seizures were the risk factors of secondary epilepsy after viral encephalitis （P 〈 0.05）. There was no significant difference of time of fever, age, percentage of paralysis of limbs, abnormal computer tomography （CT） and abnormal cerebrospinal fluid （CSF） between the secondary epilepsy group and control group （P 〉 0.05）. Thirty cases with secondary epilepsy were treated by anti-epilptic drug. The effective rate was 80%. Conclusion： A long history of having seizures and slow time of recovery to EEG are the risk factors of secondary epilepsy after viral encephalitis in children. Active controlling seizures during viral encephalitis can reduce the incidence of secondary epilepsy.