合闭眼状态和光刺激对儿童癫痫样放电的影响

Effect of eyes closure, eyes closed and photic stimulation on the epileptiform discharges in children with epilepsies

目的了解合闭眼状态对儿童癫疴样放电的诱导作用及合闭眼敏感性与光敏感性的关系。方法录像EEG监测时，对癫痫患儿进行反复睁闭眼试验及不同眼状态下间断闪光刺激（intermittent photic stimulation，IPS）。将眼状态分为睁眼（eyes opened）、合眼（eyes closure，睁眼后合上眼的最初3s内）及闭眼（eyes closed，保持闭眼3s以上直至睁眼之前）。合眼或闭眼时诱发癫痫样放电现象称为合眼敏感性或闭眼敏感性。从135例中筛选出具有合眼敏感性或闭眼敏感性的13例患儿，对其临床、合闭眼敏感性及其与光敏感性的关系进行分析。结果13例中女8例，男5例，平均就诊年龄为11岁，平均起病年龄为9岁。相关的癫痫及癫痫综合征诊断包括反射性癫痫中的特发性光敏感性枕叶癫痫2例；早发型良陛儿童枕叶癫疴3例；晚发型儿童枕叶癫痫1例；少年肌阵挛癫痫2例；眼睑肌阵挛伴失神1例；仅有全身强直-阵挛发作的反射性癫痫1例；癫痫伴觉醒期大发作1例；症状性枕叶癫疴及症状性全身性癫痫各1例。13例中合眼敏感性10例，8例伴光敏感性，其中6例合眼状态下IPS阳性，6例中4例闭眼状态下IPS亦阳性、2例阴性；闭眼敏感性3例，2例伴光敏感性，其中1例合眼和闭眼状态下IPS均阳性。合眼和闭眼诱发的EEG放电图形和部位未见特征性区别，均与癫痫发作类型相关性更强。不同眼状态下光敏感的阳性检出率及阳性频率范围有一定的差异。4例给予丙戊酸钠治疗后复查EEG发现合闭眼敏感性及光敏感性均有改善，且光敏感性可先于合闭眼敏感性好转。结论合闭眼敏感性较常见于女性患儿，可涉及多种癫痫综合征。合闭眼敏感性与光敏感性可共存亦可独立存在。录像EEG监测时对癫疴儿童常规进行合闭眼状态测试及不同眼状态下IPS测试，有助于发现癫痫样放电，并协助临床诊断及治疗。

Objective To investigate the effect of eyes closure and closed on the epileptiform discharges, and the relationship between eyes closure or closed sensitivity and photosensitivity. Methods During video-EEG monitoring, open-close eyes tests and intermittent photic stimulation （IPS） under different eyes conditions were carried out in epilepsy patients. The eyes conditions were divided into eyes opened, eyes closure （the period immediately after closing of the eyes and only lasts for less than 3s）, and eyes closed （the period lasting for more than 3s and persisting as long as the eyes remain closed）. From 135 patients, 13 cases whose EEG showed eyes closure or closed sensitivity had been selected out for our study. The clinical, eyes closure or closed sensitivity and the relationship between eyes closure or closed sensitivity and photosensitivity were analyzed. Results Of the 13 patients, 8 were female, and 5 were male. The age ranged from 6 years to 17 years （median 11 years）. The age at onset of epilepsy ranged from 1.5 years to 14.5 years （ median 9 years）. Epileptiform discharges could be provoked by eyes closure in 10 of 13 patients, associated with photosensitivity in 8 patients. Of the 8 patients, 6 cases showed photosensitivity under eyes closure and only 4 cases showed photosensitivity under eyes closed. Eyes closed sensitivity had been seen in 3 patients, with photosensitivity in 2 patients. Evoked EEG patterns and discharges regions by eyes closure and eyes closed conditions had not obvious differentia and might be strongly related to the types of epilepsies. The intensity and frequencies of photosensitivity under different eyes conditions were different. After valproate acid treatment, the eyes closure or closed sensitivity and photosensitivity improved in 4 cases, with improvement of photosensitivity prior to eyes conditions sensitivity. Conclusions Eyes closure and eyes closed could induce EEG paroxysms, which involved in some types of epileptic syndromes and appeared common in female patients. Eyes closure or closed sensitivity might coexist or be disassociated with photosensitivity. Testing eyes closure, eyes closed and IPS during EEG monitoring would contribute to finding the EEG discharges, further help to diagnose epilepsies and epileptic syndromes and guide treatment.