儿童睡眠中癫痫性电持续状态的临床及脑电特征研究

Clinical and EEG characteristics of children with electrical status epilepticus during sleep

目的 探讨睡眠中癫痫性电持续状态 (ESES)的临床、脑电图 (EEG)特征及治疗特点。方法 用 2 4小时便携式EEG或 4～ 8小时Video -EEG进行监测 ,以睡眠中限局性或广泛性棘慢波持续发放 ,达到或超过非眼快动期 (NREM)睡眠时间的 85 %作为ESES的诊断标准。结果 共有 12例各种类型的癫痫综合征患儿具有ESES的EEG特征 ,其共同特点为年龄依赖性发病 ,多种发作形式 ,慢波睡眠期持续棘慢波发放 ,精神发育或认知功能倒退 ,对氯硝基安定及丙戊酸治疗反应良好。结论 ESES不是一个独立的癫痫综合征 ,而是一种特殊的EEG现象。长时间的持续睡眠中癫痫性放电是ESES引起高级皮层功能损伤的主要原因。抗癫痫药物治疗不仅要控制癫痫发作 ,而且应有效抑制EEG的癫痫性电活动。

Objective To approach the characteristics of clinical,EEG and therapy on electrical status epilepticus during sleep(ESES).Methods Patients were selected by 24-hour ambulatory EEG and 4～8 hour video EEG monitoring.The diagnostic criterion of ESES is continuous focal or generalized spike-wave discharges during at least 85 per cent of non-REM sleep whether with or without clinical seizures.Results Eleven children with seizures and one without were diagnosed as ESES,including a few of epileptic syndromes in childhood.The common features of these epileptic syndromes were onset depending on age,multiple seizure types,continuous spike-wave discharges during slow sleep,regression of psychological or cognitive function,and good response to clonazepam and sodium valproate.Conclusion ESES is a specific EEG phenomenon rather than an independent syndrome.Long-term and continuous abnormal discharges is the main cause of impairment of higher cortical function resulted from ESES.Antiepileptic therapy should not only control clinical seizures,but also inhibit epileptic discharges.