影响儿童非癫痫发作性障碍诊断的因素

Influence factors on correct diagnosis of non epileptic paroxysmal disorders in childhood

目的：探讨儿童非癫痫性发作（ＮＥＳ）的诊断及其影响因素。方法：根据２４ｈ动态脑电图（ＡＥＥＧ）监测，综合分析病史、体格检查、神经系统检查及影像学资料。结果：ＮＥＳ合并癫痫者占所有病例的２８％；单纯ＮＥＳ癫痫样脑波检出率为１０％；有脑器质性损害者，ＮＥＳ合并癫痫占３２％，单纯ＮＥＳ占１１％；单纯ＮＥＳ使用抗癫痫药者占１８％，合并癫痫而加用抗癫痫药者达５０％。结论：ＡＥＥＧ是鉴别ＮＥＳ与癫痫发作的较好方法；ＮＥＳ发作形式，ＮＥＳ与癫痫并存，癫痫样脑波，脑器质性损害证据及抗癫痫药滥用是影响ＮＥＳ诊断的主要因素。

To investigate the influence factors on correct diagnosis of non epileptic seizures(NES) in childhood, we analyzed 24h ambulatory electroencephalography(AEEG) and clinical features of the attacks in 159 children with NES. The results showed that 28% of all patients were identified as NES plus epileptic seizures. Epileptiform EEG discharges were observed in 10% of pure NES children. Abnormal findings on neurodiagnostic evaluation were obtained in 32% of NES plus epileptic seizures groups, in 11% of pure NES groups. Unnecessary anti epileptic drugs were received in 18% of pure NES children and the kind or doses of the medicines were increased in 50% of NES plus epileptic seizure children who had been mistaken for refractory epilepsy. The influence factors on correct diagnosis of NES are mainly; variability of non epileptic seizure expression, interictal epileptiform EEG discharges, neurologic abnormal findings, and anti convulsant abuse.