小儿失神癫痫临床特征和药物治疗观察

Clinical feature and observation of medicinal treatment in childhood absence epilepsy

目的 探讨小儿失神癫痫 (CAE)的临床特征及评价药物的疗效。方法 对 34例CAE的临床及实验室资料进行回顾性分析。结果 本组起病年龄是 4～ 11岁 ,4～ 8岁患病为多 (6 5 % ) ;简单失神 14例 (4 1% ) ,复杂失神 2 0例 (5 9% )。对 2 5例患儿取立位进行过度换气诱发实验 ,目测结果 :15例复杂失神可伴有不同临床表现 ,7例为简单失神。 34例异常脑电图 (EEG)为突然自发或过度换气后呈现双侧对称同步的 3Hz棘慢综合波。32例中 2 8例 (88% )智商 (IQ)正常 ,4例为边缘状态。本组患儿脑CT、MRI均正常。 34例均首选单药治疗 :2 6例用丙戊酸钠 ,5例用德巴金缓释片 ,用药至发作停止时间是 4天至 6个月 ,其中 <1个月者 18例 (5 8% ) ;另 3例单药治疗期间因故改用多药治疗。随访 6个月至 4年 ,单药治疗 31例中 2 5例 (80 % )完全控制发作平均 2年。结论 CAE发作分型的诊断 ,是依据临床表现及EEG特征。

Objective To investigate the clinical feature and evaluate the effectiveness of medicinal treatment in childhood absence epilepsy(CAE).Methods A retrospective investigation was performed to analyse the clinical and laboratory data in 34 patients with CAE.Results The onset age of CAE ranges from 4 to 11 years old,with a peak around 4 to 8 years(65%).IQ was normal in 28 of 32 patients with CAE.14 patients(41%) were simple absence ,and 20(59%) complex absence.All patients had EEG pattern with a bilateral symmetric and synchronous discharge of regular 3Hz spike-wave discharges after spontaneity or hyperventilation.Brain CT or MRI was normal in 34 patients and valproic acid(VPA) was the drug of first choice.Twenty-six patients received VPA,five patients were treated with depakine chrono.The period from the initiation of anticonvulsant to the discontinuation of clinical attack was during 4 days to 6 months,18 patients(58%) were less than one month,3 patients were altered to double-drug therapy.6 months to 4 years follow-up was carried out,during which 25 out of 31 patients were controlled by single drug.The average duration for complete controlling needs 2 years.Conclusion\ The typing of CAE depends on both clinical and EEG features.VPA was the first-line drug in treating CAE.