儿童14Hz&6Hz正相棘波79例临床分析

A Retrospective Study of 79 Children With 14 Hz&6 Hz Positive Spikes

目的探讨14 Hz&6 Hz正相棘波的脑电波特点与临床意义。方法对2005年8月至2007年6月在四川大学华西第二医院小儿神经科接受4 h清醒-睡眠-清醒视频脑电图(video- electroencephalogram,video-EEG)连续监测的1 321例患儿中,79例出现14 Hz&6 Hz正相棘波的患儿临床资料和脑电图进行回顾性分析。结果本组患儿资料显示,14 Hz&6 Hz正相棘波在脑电图特征、年龄、性别分布:均在非快速眼动期睡眠(non-rapid eye movement sleep,NREM)出现,集中于中、后颞区,一侧或双侧发放,常波及中央、顶、枕区,呈连续发放(1岁以下未见)。男、女患儿14 Hz&6 Hz正相棘波出现几率比较,差异无显著意义;癫痫患儿与非癫痫患儿的出现几率比较,差异无显著意义。本组79例出现14 Hz& 6 Hz正相棘波的患儿,均有突出的精神运动发育迟滞、小儿急性偏瘫、过敏性紫癜、脑挫伤、颅内感染等器质性病变,癫痫发作和反复多次发作或有阳性家族史的热性惊厥,头痛、腹痛、晕厥、呕吐等自主神经症状,存在注意力缺陷、心理问题、抽动等精神行为障碍及睡眠障碍,1例死亡。本组79例患儿中,63例睡眠期脑电监测出现14 Hz&6 Hz正相棘波的多次频繁发放。结论对于14 Hz&6 Hz正相棘波的临床诊断价值问题迄今尚存争议,还有待大量不同年龄段正常儿童连续睡眠脑电图资料的积累。因此,不能将14 Hz&6 Hz正相棘波用于诊断癫痫或其他发作性疾病,但也不能简单地将其认作发育期的正常脑波表现,一旦临床监测到,应积极作其他相关检查,寻找病因,以免漏诊。

Objective To investigate the significant features and clinical significance of the 14Hz＆6Hz positive spikes electroencephalogram（EEG）. Methods A retrospective study on 79 children with 14Hz＆6Hz positive spike pattern in 1 321 video EEG from the Department of Pediatrics , West China Second University Hospital, Sichuan University from August 2005 to June 2007, and their clinical features and electrogram were analyzed. All the 1 321 video-EEG records were obtained with the ＂10-20＂ international system of electrode placement and 16-channel EEG machine, and their wakefulness, drowsy state, sleep and waking up state were monitored and recorded continually. Results A total of 79 children have been found with the 14Hz＆6Hz positive spike pattern in 1 321 patients. The statistics indicated that there was no significant difference in EEG＇s features, gender and age distributions of the 14 Hz＆6 Hz positive spikes, according to the previous reports： the 14Hz＆6Hz positive spikes occured almost during drowsiness and light sleep, appeared in mid-posterior temporal concentratly, discharged continually in unilateral or bilateral encephalic region and did not found in infants under 1-year-old; there was no significant difference between boys and girls in incidence rate and no significant difference between epilepsy group and non-epilepsy group in incidence rate. But differently, all children had noticeable symptoms, including organic disease （such as mental retardation, acute hemiplegia, anaphylactoid purpura, brain contusion or intracranial infections）, seizures or complicated febrile convulsions, autonomic nervous symptoms （for example headache, abdominal pain, fainting and vomiting）, mental or behavior disorders （such as Attention deficit hyperactivity disorder, psychological problems and tic disorder） and dyssomnia. Most of them had the 14Hz＆6Hz positive spikes discharged many times or frequently. Only one child died. Conclusion The 14 Hz＆6 Hz positive spikes is nonspecific abnormal EEG and can not be regarded as epileptic activity or a paroxysmal disease directly, but it also can not be regarded as a normal EEG appearing in period of brain development negligently. More investigations are required in order to search causes of the disease and avoid missed diagnosis.