伴发癫痫的病毒性脑炎患者的临床表现和影像及脑电图分析

Clinical,Imaging and EEG Analysis in Patients with Viral Encephalitis Accompanying Epilepsy

目的探讨伴发癫痫的病毒性脑炎患者的临床表现、影像及脑电图(EEG)检查对其诊断、治疗有效性及预后评价的价值。方法回顾性分析23例伴发癫痫的病毒性脑炎患者的临床表现、影像特征及EEG改变,并对部分患者进行EEG随访;结果23例病毒性脑炎患者以癫痫形式起病的有9例(占39.1%),其中病程中伴发全面强直-阵挛发作(GTCS)者有19例(占82.6%),19例GTCS患者中有3例(占15.8%)为简单或复杂部分性发作所继发。患者发病初期EEG均出现异常,6例患者在发病后4周复查EEG,其中5例临床症状未完全恢复的患者EEG异常程度没有改变,1例病情完全恢复的患者EEG由重度异常变为轻度异常。3例患者出院半年后复查,EEG异常程度均有所减轻。结论患者的临床表现、影像学表现及EEG检查对病毒性脑炎合并癫痫患者的诊断、判断治疗的有效性及预后评价均具有重要作用。对所有入院患者应详细询问病史并积极行影像及EEG检查。

Objective To explore the value of clinical features,imaging and EEG in diagnosing viral encephalitis accompanying epilepsy,as well as judging the efficacy of its treatment,and predicting the prognosis.Methods The clinical,imaging and EEG findings of 23 patients with viral encephalitis and epilepsy were retrospectively analyzed.And some of them were followed up for EEG.Results Of the 23 cases with viral encephalitis and epilepsy,9 cases started with seizure attack（39.1%）,19 cases had GTCS attack（82.6%） in the process,among which 3 cases had simple or complex partial seizures first（15.8%）.All the patients had abnormal EEG at the beginning of onset.6 patients undertook EEG follow-up 4 weeks after the onset,among which 5 cases without complete recovery had no changes in EEG,and 1 case with complete recovery had a-meliorated EEG.Three cases had EEG follow-up six months later and their EEG were improved remarkably.Conclusion The clinical features,imaging and EEG examination were all very helpful in diagnosing viral encephalitis accompanying epilepsy,as well as judging the efficacy of treatment and predicting the outcome of viral encephalitis.All the patients with viral encephalitis and epilepsy should be asked medical history in detail and given imaging and EEG examination actively.