额叶癫24例临床特点

Clinical Features of 24 Children with Frontal Lobe Epilepsy

目的探讨儿童额叶癫(FLE)的临床表现、EEG特点及预后,提高对FLE的认识。方法对郑州大学第三附属医院小儿神经内科门诊2009年6月-2010年6月诊治的24例FLE患儿临床资料进行回顾性分析,患儿均行24h视频脑电图(VEEG)监测和头颅影像学检查,分析儿童FLE的发作类型、发作表现、临床特点、EEG、头颅影像学表现,以及口服抗癫药物的治疗效果等。结果临床发作表现为类抽动症样发作6例(25.00%),类行为异常样发作、躯体运动性自动症各5例(20.83%),简单自动症3例(12.50%),偏转性强直发作、阵挛性发作各2例(8.33%),姿势性强直发作1例(4.17%)。以睡眠中发作为主,发作频繁,持续时间短暂,常有连续成串发作。患儿均有额区异常放电,主要表现为额区起源的尖波、尖慢波、棘波、棘慢波、多棘慢波、慢波等或以上混合,可波及中央、颞区甚至泛化全导。头颅影像学检查发现异常5例。口服抗癫药物治疗控制发作21例(87.5%),发作减少3例(12.5%)。结论 FLE临床表现复杂多样,以类抽动症样发作、类行为异常样发作及躯体运动性自动症为主要表现,发作以睡眠中为主,持续时间短暂,且常规EEG阳性率低,易误诊,长程VEEG监测可提高检出率。口服抗癫药物治疗效果良好。

Objective To explore the clinical features,EEG characteristicsand prognosis of childhood frontal lobe epilepsy（FLE） in order to improve the cognition of FLE.Methods Twenty-four children with FLE collected from Jun.2009 to Jun.2010 in the neurology outpatient of the Third Affiliated Hospital of Zhengzhou University were reviewed retrospectively.All of them were examined by skull imaging studies and monitored by 24 h vigilance-controlled electroencephalogram（VEEG）.Then the epileptic seizure types and seizure features,clinical characteristics,manifestations of EEG and iconography,therapeutic effects of antiepileptic drugs were analyzed.Results The seizures types were as follows：seizures of tic like（6 cases,25.00%）,seizures of abnormal behaviors like（5 cases,20.83%）,hypermotors（5 cases,20.83%）,automatisms（3 cases,12.50%）,torsive seizures（2 cases,8.33%）,clonic seizures（2 cases,8.33%）,asymmetric tonic seizures（1 case,4.17%）.FLE typically came in short bursts that last less than 1 minute and often occur frequently while sleeping.All children had abnormal amount of discharge area,mainly for the amount of area origin of sharp waves,sharp slow wave,spike wave,spike slow wave,multi-spike slow wave,slow wave or more mixed,affecting central,and temporal region even all the leads.Five cases of them had imaging abnormality.After treatment of oral anti-epileptics（AEDs）,21 cases（87.5%） were seizure free,and 3 cases（12.5%） got better.Conclusions Manifestations of seizures with FLE are various.The main types of seizures are tic like,abnormal behavior like,hypermotor automatisms,et al.Its features include short duration,frequent attacks and nocturnal preponderance.Routine EEG has low positive rate,so FLE has high misdiagnosis rate.The prolonged VEEG monitoring can increase the positive rate.The therapeutic effect of oral AEDs is good.