小儿脑损伤并继发性癫痫临床分析

A clinical study on secondary epilepsy of children following brain injury

目的探讨小儿脑损伤后继发性癫痫发作特点及预后。方法对56例患儿采用全身型螺旋电脑断层扫描及脑电图进行检查，并排除遗传代谢性疾病。按发作类型选择抗癫痫药物治疗，并给予运动功能训练、认知训练以及视力、听力障碍干预治疗。结果全部病例均有脑损伤病史，头颅电脑断层扫描均有不同程度改变，其中窒息20例（35．7％），颅内出血14例（25．O％），早产12例（21．4％），宫内发育不良6例（10．7％），黄疸4例（7．1％）。合并听力障碍5例（8．9％），皮质盲2例（3．6％），智力发育落后32例（57．1％），6例（10．7％）为发育边缘。经抗癫痫治疗结果1周内控制者26例（46．4％），半月内控制者20例（35．7％），1～2个月控制者8例（14．3％），2个月未控制者2例（3．6％）。结论①继发性癫痫高危因素依次为窒息、颅内出血、早产、宫内发育不良及黄疸等；②继发性癫痫可表现为不同类型发作，许多患儿早期表现为惊跳而误诊；③婴儿期继发性癫痫疗程可依原发病控制情况而定，用药后症状很快改善，控制效果好；④对高危儿脑损伤后行脑电图检查有助于癫痫的早发现、早治疗，对防治二次脑损伤发作有重要价值。

Objective To investigate seizure characteristics and prognosis of symptomatic epilepsy of children after brain injury. Methods 56 children with symptomatic epilepsy who were excepted genetic and metabolic diseases received general-slice CT and EEG examinations and were diagnosed as epilepsy. ALL children with epilepsy were treated with antiepileptics according to the type of epilepsy seizure and received motor function training and cognitive training as well as visual disturbance and heating disorder interventions. Results All children with epilepsy had brain injury history and varied degree of changes in CT, of which 20 children had asphyxia history （35.7%）, 14 children had intracranial hemorrhage history （25.0%）, 12 children had premature labor history （21.4%）, 6 children had intrauterine growth retardation （10.7%）, 4 children had neonatal jaundice history（7.1% ）. 5 children with epilepsy were accompanied with hearing disorder（8.9% ）, 2 children were accompanied with cortical blindness （ 3.8% ）, 32 children were accompanied with mental retardation （57.1%） and intelligence development of 6 children was in edge level （10.7%）. The symptoms of 26 children with epilepsy （46.4%） were controlled within a week of antiepileptic treatment, those of 20 children （35.7%） were controlled within a half month of antiepileptic treatment, those of 8 children （14.3%） were controlled in 1-2 months of antiepileptic treatment, those of 2 children （3.6%） were not controlled by the end of two months of antiepileptic treatment. Conclusion ①The high risk factors of secondary epilepsy include asphyxia, intracranial hemorrhage, premature labor, intrauterine growth retardation, jaundice and so on; ②The children with secondary epilepsy manifest different types of seizure and most of them are misdiagnosed due to only presentation of convulsion in early time; ③The course of treatment of secondary epilepsy in infancy can be determined according to primary disease control. The symptoms could be controlled quickly and effectively after treatment; ④EEG examination for those high risk infants following brain injury is helpful to early identify and treat epilepsy, which is of important value for preventing secondary brain injury.