癫癎痴笑发作8例临床分析

Clinical analysis of 8 patients with gelastic seizure

目的总结癫癎痴笑发作（GS）的病因、临床特点和临床进展，为制定临床诊疗决策提供依据。方法：2012年1月～2013年12月，结合患者头颅MRI、PET—CT和24 h视频脑电图（V-EEG）检查结果及典型GS的临床表现，收集8例门诊诊断为GS的病例进行分析。结果：根据患者的临床表现和辅助检查综合判断，6例诊断为症状性GS，2例隐原性GS。其中3例仅有痴笑发作，5例合并有1～2种其他发作类型。所有患者均接受1～3种抗癫癎药治疗，结果3例发作得到控制，2例发作减少〉50％，3例无效。结论：通过分析病历，进一步强调了除下丘脑错构瘤为常见病因外，额、颞、顶、枕等脑叶的病变也可导致GS。对MRI正常的患者，PET—CT能更好地显示病灶。对于EEG和MRI均正常的患者，典型的临床症状和诊断性治疗更有助于早期确诊及改善预后。

Objective：To explore the etiology, characteristics and clinical evolution of gelaslic seizures（GS） in patients with epilepsy provide evidence for decision of its clinical diagnosis and treatment. Methods：Eight outpatients whose seizures were characterized by typical laughing attacks were observed between January 2012 and December 2013. Patients were selected based on magnetic resonance imaging （MRI）,and on position emission tomography-computer tornography（PET-CT） study, and on video-electroencephalogram（V-EEG） recordings. Results： According to synthesis and evaluation of the patients＇ manifestation and auxiliary examination, six patients were affected by symptomatic localization-related ep- ilepsy （LRE）,and two cases were consequently classified as having cryptogenic LRE. Only three cases belonged to GS type,five patients were accompanied with one or two other seizure types. All patients received the treatment of 1 -3 kinds of anti-epileptic drugs （AEDs）. Three patients were completely seizure free with AEDs therapy,two patients had a consistent seizure reduction（〉50%）,but three patients were drug resistant. Conclusion： By analyzing the medical records, besides the common cause of hypothalamic hamartoma, the frontal, temporal, parietal,occipital lobe lesions and other brain damage are also causes of gelastic seizures. To patients with normal MRI, PET CT can be better display lesions. To patients with normal EEG and MRI typical clinical symptoms and diagnostic treatment contributes to early diagnosis and improvement of prognosis.