成人病毒性脑炎后遗症期继发性癫痫的危险因素分析

Analysis of risk factors for postencephalitic epilepsy in adults

目的探讨成人病毒性脑炎后遗症期继发性癫痫的危险因素。方法选择2008年12月～2010年12月在长海医院神经内科住院诊断为成人病毒性脑炎患者122例,分析一般情况、癫痫发作频率、意识障碍程度、神经系统阳性体征、发热以及脑电图、头颅MRI和(或)CT、脑脊液、病原学等辅助检查结果,分析病毒性脑炎后遗症期继发性癫痫的可能危险因素。结果 122例成人病毒性脑炎患者,26例(21.3%)在平均随访(4.01±1.84)个月后出现继发性癫痫,最终14例(53.8%)发展为难治性癫痫。脑炎急性期癫痫反复发作、癫痫持续状态、昏迷、局灶性脑电图异常、大脑皮质损害、脑脊液单纯疱疹病毒检测阳性为脑炎后遗症期继发性癫痫的危险因素。病毒性脑炎急性期出现癫痫反复发作或癫痫持续状态时易发展为难治性癫痫。结论病毒性脑炎后遗症期继发性癫痫的发生与脑炎急性期癫痫反复发作、癫痫持续状态密切相关。昏迷、局灶性脑电图异常、大脑皮质损害、单纯疱疹病毒感染可促进脑炎后遗症期继发性癫痫。

Objective To evaluate the risk factors for postencephalitic epilepsy in adults.Methods 122 cases of adult patients in the Affiliated Changhai Hospital of the Secondary Military Medical University from December 2008 to De cember 2010 were collected.The clinical data including general condition,seizure frequency,status epilepticus,con sciousness level,focal neurological sign,fever,electroencephalography findings,neuroimage MRI or CT findings,cere brospinal fluid parameter and central nervous system infection were analyzed.Results Of total 122 adult patients,26（21.3%） adult patients were found developed epilepsy with a mean follow-up period of（4.01 ±1.84） months,14 cases（53.8%） were found with intractable epilepsy.The presence of recurrent seizures,status epilepticus,coma,focal cere bral dysfunction in electroencephalography,focal cortical abnormalities in neuroimaging and herpes simplex virus in fection were the risk factors for postencephalitic epilepsy.Adult patients with recurrent seizures or status epilepticus refractory status epilepticus were found induced to the possibility of intractable postencephalitic epilepsy.Conclusion The presence of recurrent seizures or status epilepticus during the acute phase of viral encephalitis is the main predic tive risk factor of postencephalitic epilepsy.Coma,focal cerebral dysfunction in electroencephalography,focal cortical abnormalities in neuroimaging and herpes simplex virus infection can induce postencephalitic epilepsy.