脑性瘫痪合并癫癎的临床特征及危险因素探讨

Clinical features and related risk factors of epilepsy in children with cerebral palsy

目的探讨脑性瘫痪患儿伴发癫癎的临床特点及其相关危险因素。方法对2004-01—2005-12期间青岛市残疾儿童医疗康复中心治疗的185例脑瘫患儿进行详细的病史采集、脑电图以及影像学检查、认知功能评定,分析不同类型脑瘫患儿癫癎的伴发率、发作类型、发病年龄等临床特征,采用Logistic逐步回归分析验证性别、出生体重、新生儿期惊厥史、围生期高危因素、认知水平、影像学改变等因素对合并癫癎的影响效应。结果25.9%(48/185例)脑瘫患儿伴发了癫癎,脑瘫类型包括痉挛型四肢瘫、偏瘫、双瘫、混合型、失调型和不随意运动型。这6型脑瘫患儿癫癎伴发率依次为58.97%、31.58%、16.07%、20.69%、12.5%和7.14%;伴发癫癎的患儿中29例(60.42%)在1岁内发病,而痉挛偏瘫和失调型脑瘫伴发癫癎发病都在1岁之后。Logistic回归分析发现产时高危因素、新生儿期惊厥史、IQ/DQ低下、影像学显示皮质受损均是伴发癫癎的危险因素,早产、新生儿疾病、孕期因素与伴发癫癎无明显关系,而单纯脑白质损伤是脑瘫伴发癫癎的保护性因子。结论癫癎是脑瘫患儿的常见并发症,尤其见于四肢瘫和偏瘫,往往较早发病,以婴儿痉挛和部分性发作为主要类型。新生儿期惊厥史、IQ/DQ低下、皮质受损对脑瘫患儿伴发癫癎有预示价值。

Objective To investigate the clinical characteristics and the related risk factors of epilepsy in children with cerebral palsy. Methods We conducted a clinical study based on the special hospital. Children with CP referred to Qingdao Rehabilatation Center For Disabled Children from January 2004 to December 2005 were recruited. Their medical his- tories, EEG,imaging findings and cognitive status were reviewed to evaluate the incidence, seizure type and the onset age of epilepsy, then the logistic regression was applied to analyse the relationship between concomitant epilepsy and its risk factors, including sex, gestational age, neonatal seizure history, pathological factors during pre-, peri-, or post-natal period, intelligence level and imaging abnormality. Results The overall epilepsy incidence in CP was 25.9% （48/185）. The incidence in spastic tetraplegia,hemiplegia,diplegia, mixed and ataxia was 58.97% ,31.58%, 16.07% ,20. 69%, 12. 5% and 7. 14% respectively. Twenty-nine children （60. 42% ） had onset of epilesy before 1 year old, especially in spastic tetraplegia （ 86.96% ）. All of the hemiplegia and ataxic children had onset at 1 year later. The main type of seizures was generalized （58. 33%） including 19/48 eases of spasms, followed by partial and partial secondary generalized seizures （ 35.42% ）. The logistic regression showed that the high risk foctors during delivery, the neonate seizure history, low IQ/ DQ level and the cortex impaired on imaging were the related risk factors of epilepsy, and prematurity, neonate diseases and. pregnancy pathology were not while pure white matter damage was the protective factor of epilepsy in CP. Conclusion Epilepsy is a concomitant disease of CP, especially in tetraplegia and hemiplegia. It usually attacks at an earlier age, and is mainly presented by the infant spasms and partial seizures. Neonate seizure history,low IQ/DQ level and brain cortex impairment may predict the implication of epilepsy in CP.