脑性瘫痪伴癫痫患儿32例影像学及脑电图特征分析

Analysis of imageology and electroengephalogram characteristics of children with cerebral palsy and epilepsy:on 32 cases report

目的探讨脑性瘫痪合并癫痫患儿的临床特点和影像学、脑电图特征。方法总结在该院小儿科住院的脑性瘫痪合并癫痫患儿的癫痫发生率、临床类型、头颅计算机体层成像(CT)、脑电图等方面的特点以及抗癫痫治疗效果。结果 139例脑性瘫痪患儿中有32例合并癫痫,占23.0%;常见的癫痫类型为强直—阵挛发作12例(37.5%)和部分性发作6例(18.8%);癫痫多发生于痉挛性脑性瘫痪(68.8%);25例(78.1%)癫痫首发于1岁前;合并癫痫患儿的头颅影像异常及脑电图异常分别为30例(93.8%)和27例(84.4%),而未合并癫痫患者分别为75例(81.5%)和20例(35.7%),脑电图异常率比较差异有统计学意义(P<0.05)。32例合并癫痫患儿常见的头颅异常为脑发育不良11例(36.7%)、脑积水6例(20.0%),余为脑萎缩、缺氧缺血性脑病样改变等13例(43.3%);脑电图异常中局灶性和弥漫性异常所占比例为48.2%和51.9%;81.2%的癫痫患儿需要2种及2种以上的抗癫痫药物治疗。结论脑性瘫痪患儿中癫痫的发生率较高,其头颅影像学和脑电图分别以脑发育不良和弥漫性异常为主;脑性瘫痪儿童的癫痫大多为难治性,需要联合用药治疗。

Objective To explore the imageology and electroengephalogram characteristics of children with cerebral palsy and epilepsy.Methods Summed up the incidence of epilepsy,clinical type,the age of first seizure,brain computer tomography（CT）,electroencephalogram,and therapeutic effect on epilepsy in chileren with cerebral palsy and epilepsy.Results 139 cases children with cerebral palsy were 32 cases children（23.0%） with epileptic.The common type of epilepsy were tonic-clonic（12 cases,37.5%） and partial（6 cases,18.8%）;Epilepsy offten occurred in the spastic cerebral palsy（68.8%）;25 cases（78.1%） children with epilepsy occurred in under the age of one year;The percentages of abnormal braen image and electroencephalogram were 30 cases（93.8%） and 27 cases（84.4%） respectively,but children not with epilepsy were 75 cases（81.5%） and 20 cases（35.7%）,the rate of electroencephalogram abnormalities was statistically significant difference（P0.05）.The main abnormal brain images were cerebral hysplasia（11 cases,36.7%） and hydrocephalus（6 cases,20.0%）;The percentages of focal and diffused changes in EEG were 48.2% and 51.9%.Some cerebral palsy children（81.2%） should be treaed by polytherapy with 2 or more than 2 antiepileptic drugs.Conclusion The incidence of epilepsy in cerebral palsy children is high.The main changes of brain image and electroencephalogram are cerebral hyspladia and abnormal background activities with epileptic waves respectively.Most of the epilepsies in children with cerebral palsy are intractable,need combination therapy.