热性惊厥临床和脑电图特征与日后癫痫发生关系的研究

Relationship between clinical and electroencephalographic characteristics of febrile seizures and subsequent epilepsy

目的:探讨热性惊厥(Febrile seizures,FS)患儿脑电图(Electroencephalogram,EEG)特征,揭示EEG阵发性异常与日后发生癫痫的关系。方法:对我院儿科门诊和住院就诊的165例FS患儿于体温恢复正常后7～20 d进行视频脑电图(Video-electroencephalogram,VEEG)监测,EEG结果根据阵发性出现棘慢波、尖波或棘波而定位,探讨EEG阵发性异常放电与FS患儿日后发生癫痫关系。结果:本组165例患儿VEEG异常60例(36.36%),其中45例日后发生癫痫。EEG异常率与患者年龄、癫痫家族史、发热温度、FS类型、发作类型、24 h内发作超过1次及惊厥持续时间有密切关系。8例广泛性棘慢波者日后发生癫痫的有2例(25%),14例Rolandic区放电9例(64.3%)发生癫痫,21例枕区放电的18例(85.7%)发生癫痫,17例额区放电16例(94.1%)发生癫痫。与广泛性放电相比,额区放电的危险相关系数为48.0。结论:额区阵发性异常放电的FS患儿日后发生癫痫的危险性更大。

Objective：To investigate the electroencephalographic characteristics of febrile seizures（FS）and to indicate the relationship between abnormity of electroencephalogram（EEG）and subsequent epilepsy occurrence.Methods：Totally 165 patients with FS were referred from the outpatient and inpatient department for video-electroencephalogram（VEEG）within 7-20 d after the seizure.VEEGs were classified as paroxysmally abnormal based on the presence of spikes,sharp waves or spike-wave complexes.The relationship between paroxysmally abnormal EEG and subsequent epilepsy occurrence was discussed.Results：Of the 165 patients with FS,60（36.36%）revealed paroxysmal abnormality on VEEG and 45（75%）developed epilepsy.The abnormal rate of VEEG was closely related with age,family history of EP,fever temperature,FS type,types of seizures,more than one seizure within 24 h and the duration of seizures.Of the 8 patients with generalized paroxysmal spike and wave activity,2（25%）developed epilepsy.Of the 14 patients with rolandic discharge（RD）,9（64.3%）developed epilepsy.Of the 21 patients with paroxysms in the occipital region,18（85.7%） developed epilepsy.Of the 17 patients with paroxysms in the frontal region,16（94.1%）developed epilepsy.Compared with generalized EEG foci,the relative risk（RR）for patients with frontal EEG foci was 48.0.Patients with frontal EEG paroxysms had significantly higher risk of developing epilepsy than those with paroxysms in other regions of EEG foci（P=0.003）.Conclusion：These findings suggest that patients with FS presenting frontal paroxysmal EEG abnormalities may be at risk for epilepsy.