苯妥英钠脑病

Diphenylhydantoin encephalopathy

为了尽早对苯妥英钠（ＤＰＨ）脑病作出诊断以保护癫痫儿童的智力。方法对３３例ＤＰＨ脑病进行了分析，对其中２４例进行了修订韦氏成人智力量表（ＷＡＩＳ－ＲＣ）及韦氏儿童智力量表（ＷＩＳＣ）测验并与性别、年龄、病情相匹配的另外２４例接受卡马西平（ＣＢＺ）治疗的病人及２４例正常者进行了比较。结果全部ＤＰＨ脑病病人均系长期ＤＰＨ治疗和血药浓度偏高的患者，主要临床表现提示进行性恶化的智力衰退，反应迟钝及思睡，癫痫发作可能增多，脑电图（ＥＥＧ）慢波及痫样放电增多，可有脑脊液（ＣＳＦ）蛋白中等增高。神经系统症状体征一般在减药或停药后明显好转或消失。ＷＡＩＳ－ＲＣ及ＷＩＳＣ的分数在ＤＰＨ组明显比ＣＢＺ组及正常组低，Ｐ值分别为＜０．０５及＜０．０１，这说明长期用ＤＰＨ治疗可能对智力有害。结论如果能慎重选用抗癫痫药，防止ＤＰＨ脑病的发生。

Objective In order to find out some possible way to improve or protect the intelligence of the epileptics. Method 33 of them with diphenylhydantoin encephalopathy were analysed. 24 of them who had received diphenylhydantoin were tested with the Wechsler Adult Intelligence Scale Revised China (WAIS RC) and Wechsler Intelligence Scale for Children (WISC) compared with another 24 patients who received carbamazepine (CBZ) therapy and had matched up sexes, aged and disorders and also with 24 normal subjects. Results The results showed that the patients with DPH encephalopathy were all seen in long term treatment with DPH and the blood levels of DPH were nearly in the toxic range. The main clinical features revealed progressive deterioration of intelligence, mental retardation and somnolence. The patients might have an increase in epileptic seizure frequency and more slow waves and discharge on the EEG, and might be a moderate increased in CSF protein. In generally, the relative neurological symptoms and signs mentioned above could improve or disappear after the reduction in dosage or cessation of DPH therapy. The scores of the test with WAIS RC and WISC in the DPH group were significantly lower then those of the CBZ group or the normal group ( P<0.05, P<0.01, respectively). The results indicated that the long term use of DPH might lead to the impairment of intelligence of the epileptics. Conclusion If the DPH could carefully be chosen to be utlized to guard against the development of DPH encephalopathy, it would be a relatively good way to protect the intelligence of epileptic children.