非惊厥性癫痫持续状态临床及脑电图表现四例

The clinical features and EEG findings of nonconvulsive status epilepticus

目的由于非惊厥性癫痫持续状态(NCSE)的临床表现及脑电图的变化在儿童和成人很难被识别,容易被误诊,本研究主要是探讨NCSE的临床特点及脑电图表现。方法收集我院诊治过的4例NCSE患者的临床资料及脑电图资料,分析其特点。结果 4例患者既往均有癫痫发作。例1患者停药后出现NCSE发作,例3、例4患者由于药物控制不佳,例2患者的NCSE均发生在惊厥发作后,每次发作持续时间从0.5h至3d不等。例2、例3及例4患者反复多次出现NCSE。4例患者均表现为行为异常,例1、例2及例4患者发作时不讲话,不能和外界进行交流,例3患者发作时构音不清。随访后发现例2、例3患者记忆力下降,例1、例4患者智能基本正常。从脑电图来看,均表现为持续性棘慢波发放。例1为失神发作癫痫持续状态,例2、例3及例4为部分性发作癫痫持续状态。结论 NCSE在早期易漏诊,反复NCSE可导致患者记忆力下降,如癫痫患者出现持续半小时以上的行为异常等表现,应急行脑电图检查明确是否NCSE,使用苯二氮卓类及抗癫痫药物可终止NCSE。

Objective The diagnosis of nonconvulsive status epilepticus （NCSE） was often difficult and likely remains misdiagnosed in children and adults due to variations in the clinical manifestations and electroencephalographic（EEG） findings. The aim of our study was to investigate the clinical features and EEG findings of NCSE. Methods We collected and analyzed the clinical data and EEG characteristics of 4 patients with NCSE. Results Four patients had seizure history before NCSE. The causes of NCSE were different including drug withdrawal （ case 1 ）, poor drug control （ case 3 and case 4 ） and post - seizures （ case 2 ）. The duration of NCSE ranged from half an hour to 3 days. Three patients had repeated attack of NCSE. Four patients showed behavior disorder. Three patients could not talk with others and one patient presented dysarthria. Following - up showed that patient 2 and 3 had cognitive decline and other 2 patients had normal intelligence. All patients presented continuous spike and slow wave discharge in EEG findings. Case 1 showed absence status epilepticus and other were partial status epilepticus. Conclusion NCSE is likely misdiagnosed in early stage. Repeated occurrence of NCSE causes cognitive impairment in patients. If epileptic patients have behavioral disorder, EEG must be completed to confirm NCSE. NCSE is sensitive to benzodiazepines and antiepileptic drugs.