伴高热惊厥史的儿童癫癎病例分析

Analysis of children epilepsy with history of febrile convulsion

目的 分析伴高热惊厥史的癫疒间 患儿的临床特点 ,探讨高热惊厥脑损伤及其与颞叶癫疒间 的关系。方法 对 1996～ 1999年本院儿科神经病房 480例住院癫疒间 患儿进行回顾性分析 ,包括首发年龄、家族史、持续时间、癫疒间发作类型、神经影像学及脑电图改变等。结果 115例 (2 3 9% )患儿有前期高热惊厥史。伴高热惊厥史的患儿癫疒间 发作早且易于出现癫疒间 持续状态。与无高热惊厥史的患儿相比 ,伴高热惊厥史的患儿强直 阵挛发作较多 ,复杂部分性发作较少。 40 8例患儿曾行影像学检查 ,4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史的癫疒间患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫疒间 患儿。有 6 0 8% (7/ 115 )伴高热惊厥史的癫疒间患儿和 6 84% (2 5 / 36 5 )无高热惊厥史的癫疒间患儿脑电图表现为单纯颞叶异常放电 ,二组相比无明显差异。结论 在癫疒间患儿中 ,高热惊厥可能伴有脑损伤 ,且可能与后期的癫疒间 发生有关 。

Objective To investigate clinical characteristics in children with epilepsy who have a history of preceding febrile seizures,the possible brain damage with febrile seizures,and the relationship of prior febrile seizures to temporal lobe epilepsy.Methods 480 children who were admitted to our pediatric neurological unit from 1996 to 1999 were studied by retrospective analysis including age at onset,family history,status epilepticus and seizure type,neuroimaging and EEG. Results 115(23 9%) cases had preceding history of febrile seizures.Children with febrile seizures were younger at onset of epilepsy,and were more likely to develop status epilepticus.Compared with children without febrile seizures,children with prior febrile seizures had more tonic clonic onset,fewer complex partial seizures.Imaging studies were performed in 408 children(85%),of the 4 children whose imaging studies demonstrated hippocampal atrophy,none had a history of febrile seizures.Interictal EEG focal epileptic discharges were fewer in epileptic children with prior febrile seizures.Epileptic discharges were temporal focus in 6 08%(7/115) children with prior febrile seizures and 6 84%(25/365) children without prior febrile seizures,no significant differences were seen between two groups. Conclusions In epileptic children,preceding febrile seizures might cause brain damage and may be related to later epilepsy.But in children with prior febrile seizures,their epilepsies are not necessarily be temporal lobe epilepsy.