儿童脑卒中后癫痫的临床特征研究

Clinical analysis of post-stroke epilepsy in children

【摘要】目的探讨儿童脑卒中后癫痫的临床特征、治疗及预后。方法回顾性分析2009年1月至2013年3月广东省人民医院儿科收治的69例脑卒中后癫痫患儿的病因、临床特征、辅助检查、治疗和预后资料。结果脑卒中后癫痫发生率为26．5％（69／260例），男女发生率比较差异无统计学意义（x2=0．725，P=0．394），蛛网膜下腔出血患儿脑卒中后癫痫的发生率最高，为47．8％（11／23例），脑出血为34．6％（27／78例），脑缺血组最低为19．5％（31／159例），不同脑卒中类型的脑卒中后癫痫发生率比较差异有统计学意义（x2=12．000，P=0．02）。早发性癫痫占76．8％（53／69例），迟发性癫痫占23．2％（16／69例），早发性癫痫多见于出血性脑卒中，迟发性癫痫多见于缺血性脑卒中，差异有统计学意义（r=4．778，P=0．029）。早发性癫痫脑电图背景波普遍变慢。脑出血组以全面性发作为主，占70．4％（19／27例），脑缺血组以部分性发作为主，占54．8％（17／31例），蛛网膜下腔出血组90．9％（10／11例）为全面性发作，3组脑卒中后癫痫类型的分布比较差异有统计学意义（，=8．461，P=0．015）。皮质病灶继发癫痫占77．6％（45／58例），皮质下病灶继发癫痫占22．4％（13／58例）。对规律服用抗癫痫药物患儿随访6个月～4年，81．2％（56／69例）的患儿临床发作控制。结论儿童脑卒中后癫痫的发生率较成人高，多见于出血性脑卒中，尤以蛛网膜下腔出血的发生率最高，常规抗癫痈药物治疗有效。

Objective To analyze the clinical features, treatment and prognosis of children with post-stroke epilepsy. Methods Sixty-nine children with epilepsy after cerebral stroke who were admitted to Guangdong General Hospital from Jan. 2009 to Mar. 2013 were retrospectively reviewed, including etiology, clinical features, laboratory exa- minations,treatment and prognosis. Results Among 260 stroke patients,69 of them（26.5% ） developed epilepsy,but there was no significant difference between boys and girls （X2 = 0. 725,P = 0. 394）. The incidence of post-stroke epilep- sy differed significantly among different types（x2 = 12. 000 ,P = 0.02 ） , highest in the children with subaraehnoid hem- orrhage （47.8% , 11/23 cases ） , followed by those with cerebral hemorrhage （ 34.6% , 27/78 cases ） , and lastly, those with cerebral isehemia （19. 5%, 31/159 cases）. Among them, 53 patients developed seizures in the early stage （76. 8 % ,53/69 cases） , others in the late stage （23.2% , 16/69 cases） , early-onset epilepsy was more common in hem- orrhagic stroke and late-onset epilepsy was more common in isehemie stroke, which differed significantly （X2 = 4. 778, P = O. 029 ）. The electroencephalogram background generally showed slow-wave in the early-onset epilepsy. The compo- sition of seizure types differed significantly among different types of stroke （X2 = 8. 461 ,P = 0. 015 ）. Forty-five of 58 patients （77.6%） suffered from cortical lesions and 13 of 58 patients （22.4%） suffered from subcortical lesions. Those children with post-stroke epilepsy who regularly use of antiepileptie drugs were followed up for 6 months to 4 years,81.2% （56/69 cases）of clinical seizures were controlled. Conclusions The incidence of epilepsy after stroke is higher in children than in adults, cerebral stroke seizure occurs more commonly in cases with hemorrhagic stroke, es- pecially with subarachnoid hemorrhage. Conventional antiepileptic treatment is effective.