婴儿痉挛促肾上腺皮质激素治疗前后视频脑电图评估

Video-EEG evaluation of infantile spasms before and after ACTH therapy

目的评价视频脑电图(Video-EEG,VEEG)观察婴儿痉挛促肾上腺皮质激素(ACTH)治疗前后脑电图变化的价值。方法对2005—2007在山东大学齐鲁儿童医院住院的50例婴儿痉挛行VEEG长时间监测,对治疗前后VEEG进行分析,包括高峰失律、棘慢波发放、纺锤波、间隙期棘波群和发作时棘波节律等,并观察对称性痉挛、不对称性痉挛、发作间期对称性背景波、发作间期不对称性背景波、对称性高峰失律、不对称性高峰失律等与预后的关系。结果ACTH治疗2周后无论症状性还是隐源性婴儿痉挛,高峰失律均基本消失。ACTH对症状性婴儿痉挛长期疗效不佳,痉挛易复发。治疗后的VEEG多为慢波、棘波和棘慢波,再次出现高峰失律很少;抗癫痫药不能明显减少部分发作;部分发作伴成串发作者均为继发者或预后不良者,不对称性痉挛或微小发作者和不对称性高峰失律大多为继发性或预后不良者。结论VEEG是评价婴儿痉挛治疗预后的有效方法。

Objective To evaluate treatment responses by video-EEG in Infantile spasms （IS/West syndrome, WS）. Methods Clinical data and EEG findings were subjected to the comparison in 50 cases based on long-term VEEG （VEEG） recordings. Spasms were recorded in 50 infants before and after treatment.EEG analysis was performed visually for hypsarrbytbmia , muhifocal spikes, asymmetrical interictal background activity EEG, symmetrical interictal back- ground activity EEG, asymmetrical or subtle spasms, symmetrical motor spasms, etc. Results Hypsarrbytbmia almost disappeared in symptomatic or cryptogenic WS after treatment. Partial seizures （PS） did not respond to any treatment. The existence of PS with cluster might contribute to etiologic diagnosis, and they were all unfavourable outcome or symp- tomatic WS. Asymmetrical or subtle spasms, asymmetrical hypsarrhytbmia were almost all symptomatic WS or unfavourable outcome. Conclusion VEEG may contribute to etiologic diagnosis and prognostic evaluation.