大剂量泼尼松治疗婴儿痉挛患儿脑电图变化的观察

Changes of EEG in chidren with infantile spasm during high-dose prednisone treatment zA Pilot Study

目的：分析大剂量泼尼松（prednisone）治疗婴儿痉挛（infantile spasms。IS）前后脑电图（EEG）变化的特点。方法：采用大剂量泼尼松治疗13例IS患儿并对其进行开放自身对照性研究，分别于治疗前、治疗2周、疗程结束（7周）及随访6个月时进行视频脑电圈（V-EEG）监测及痉挛发作评估，并分析其治疗前后各时段EEG变化的特点及临床疗效与EEG高度失律型波消失闻的关系．缩果；13例患儿在应用大剂量泼尼松治疗前发作闻期EEG均出现商魔失律现象．伴有成绞性或单次痉挛发作，且可见发作期特征性图形。治疗后,13例患儿EEG均有不同程度改蒋，虽完全缓解戒部分缓解’，在治疗2周和7周时高度失律完全缓解率均为62%（8／13），同期癌颦发作完全控制率分别为69％（9／13）和77％（10／13）;有10例完成6个月随访，其中5例EEG星完金缓解。其余5例EEG高度失律与治疗前相仿，此5例为复发或治疗无效的瘸例；并对晃发作和宥发作患儿的勘粥高度失律背泰缓解或未消失率比较，在治疗2周时两者比较差异晃统计举意义（P＞0。05）,而治疗7周时两者比较差异有统计学意义（P〈0．05）。结论：EEG是评估临床疗效的重翼指标；大剂量泼尼松治疗IS既可在短期内快速消除高度失律。也可有效控制痉挛发作。但其是番可长期改善IS患儿的EEG及控制痉章发作俺扩大样本进一步研究及随访。

Objective, To analyse the chetracteristics of V-EEG before and after infantile spasms treated with high-dose perdnisons, Mathold, Thirteen children with infantile spasm（IS） in our hospital from June 2011 to February 2012 were prospectively observed and the assessment of spasms seizure and V-EEG monitoring were performed before the therapy,after two weeks and the end of treatment （7weeks）, after six months, respectively. We analyzed the characteristics of V-EEG changes in each period and the relationship of between the effeet and the rate of hypsarrhythmia disappeared. Results： Hypsarrhythmia in all 13 cases appeared in the interphase before treated with high-dose prednisone. Cluster spasms or single spasm and the characteristics of V-EEG were recorded. After the treatment,the V-EEG of all 13 cases were improved at different level,namely complete or partial resolution of hyparrhythmia.The rate of hypsrrhythmia disappear was 62~ （8/13） and the rate of seizure-free was 69% （9/13）and 77%（10/13） in the 2nd week and 7th week respectively. Ten cases completed six months＇ follow-up, among which the V-EEG of 5 cases were completed remission and the otherswere typical of variant hypsrrhythmia. The rate of hypsrrhythmia disappear was significantly different between the epileptic seizure controlled and uncontrolled children（P=O. 035） in the 7th week but not in the 2nd week. Conclusion： V-EEG can provide an important evidence in evaluating the effect of high-dose prednisone in children with IS. High-dose prednisone can not only clear up hypsrrhythmia in the short time, but also can effectively control the spasms. However, further follow-up and larger sampling are needed to confirm whether the treatment protocols can improve the V-EEG of IS children and control the spasms in the long term.