癫痫患者5572例病因分析

Analysis of causes of epilepsy in 5572 cases

目的回顾性收集5572例住院癫痫患者的临床资料，分析不同年龄段患者可能的病因并了解病因的构成。方法收集2003年1月1日至2009年12月30日在我院癫痫中心就诊的住院癫痫病例5572例，根据国际抗癫痫联盟（ILAE）2005年提出的癫痫诊断标准，由癫痫专科医师诊断为癫痫。依据病史、头部影像学及病理学资料将全部病例分为特发性、症状性、隐源性3类。参考ILAE2001年癫痫相关疾病的分类，将症状性癫痫病因按脑外伤、围产期损伤、中枢神经系统感染、脑血管病、脑肿瘤、脑皮质发育畸形、神经皮肤综合征和其他病因进行分类。采用非参数分析的多样本秩和检验比较热性惊厥和癫痫家族史在癫痫病因中的作用及诊断价值。结果5572例患者中，特发性66例，症状性2834例，隐源性2672例，分别占总体的1％，51％和48％。症状性癫痫患者中脑外伤822例、围产期损伤497例、中枢神经系统感染360例、脑肿瘤249例、脑血管病150例、脑皮质发育异常135例、神经皮肤综合征62例，其他559例。脑外伤、围产期损伤、中枢神经系统感染、脑肿瘤和脑血管病为症状性癫痫前5位。隐源性癫痫中海马硬化（或海马异常）者744例。热性惊厥[特发性：15．2％（10／66）、症状性：6．5％（185／2834）、隐源性：9．4％（250／2672）；X^2=181．393，P=0．000]和癫痫家族史[特发性：83．3％（55／66）、症状性：1．1％（31／2834）、隐源性：0．4％（12／2672）；X^2=68．354，P=0．000]在不同病因中的比例不同，其差异有统计学意义。热性惊厥史在海马硬化中的比例最高，家族史在症状性癫痫中以神经皮肤综合征比例最高。婴儿、幼儿及儿童、青少年、成年和老年期的首位病因分别是围产期损伤、围产期损伤、脑外伤、脑外伤和脑血管病。结论对5572例癫痫患者的病因分析提示特发性占1％，症状性占51％，隐源性占48％。脑外伤、围产期损伤、中枢神经系统感染、脑肿瘤及脑血管病是最主要的病因。

Objective To explore the common causes of epilepsy and the etiologic characteristics in different age groups of patients with epilepsy. Methods A retrospective survey was made in 5572 epilepsy patients in Epileptic Center of Guangdong 999 Brain Hospital from January 2003 to December 2009. According to the diagnostic criteria published in 2005 from ILAE, all the diagnoses of 5572 cases were made by epileptic specialists. Based on history, cranial MRI or CT and pathologic data, causes of epilepsy were classified into idiopathic, symptomatic and cryptogenic epilepsy. The cases of symptomatic epilepsy were further arranged into different categories in different age grades, such as head trauma, perinatal injuries, infection in central nervous system, cerebral vascular disease, brain tumor, disorders of cortical development, neurocutaneous syndrome and others. The cases with febrile seizures and family history were collected, and positive ratio of febrile seizures and family history were contrasted in different categories of cases by Kruskal-Wallis test （nonparametric test ）. Results In 5572 cases, 66 were idiopathic, 2834 symptomatic, 2672 cryptogenic, and the ratio of these causes was 1%, 51%, 48% respectively. Among 2834 cases of symptomatic epilepsy, 822 were head trauma, 497 were perinatal injuries, 360 were infection in central nervous system, 249 were brain tumor, 150 were cerebral vascular disease, 135 were disorders ofcortical development, 62 were neurocutaneous syndrome and 559 were others. In brief, head trauma, perinatal injuries, infection in central nervous system, brain tumor and cerebral vascular disease were top 5 causes of symptomatic epilepsy. Hippocampal sclerosis was found in 744 eases in those of cryptogenie epilepsy. The importance of febrile seizures （ idiopathic ： 15.2% （ 10/66 ）, symptomatic ：6. 5% （ 185/2834 ）, eryptogenie ：9. 4 % （ 250/2672 ） ; X2 = 181. 393, P = 0. 000 ） and family history （ idiopathic ： 83.3 % （ 55/66 ）, symptomatic ： 1.1% （ 31/2834）, eryptogenie ：0. 4% （12/2672） ; X2 = 68. 354, P = 0. 000 ） was statistically different in different causes of epilepsy. Febrile seizures was the most frequent in cases with hippocampal sclerosis than those with other causes, and family history was the most frequent in neurocutaneous syndrome in symptomatic cases. Perinatal injuries was the first cause in cases of infancy and childhood, head trauma was the top one in those of juvenile and adulthood, and cerebral vascular disease was the main cause in senile cases. Conclusions In the whole epileptic cases of 5572, 1% was idiopathic, 51% was symptomatic, and 48% cryptogenic. The main causes of them were head trauma, perinatal injuries, infection in central nervous system, brain tumor, and cerebral vascular disease.