左乙拉西坦联合短程氯硝西泮治疗儿童Rolandic良性癫癎睡眠中癫癎电持续状态的效果

Efficacy of levetiracetam combined with short-term clonazepam in treatment of electrical status epilepticus during sleep in children with benign childhood epilepsy with centrotemporal spikes

目的探讨左乙拉西坦（LEV）联合短程氯硝西泮（CZP）治疗儿童Rolandic癫痫（BECCT）睡眠中癫痫电持续状态（ESES）的效果。方法采用24h便携式动态脑电（AEEG）或3h视频脑电（VEEG）监测，以非快速动眼（NREM）睡眠期出现持续广泛性棘慢波发放占整个NREM期的85％以上作为ESES的诊断标准，回顾分析15例（男9例，女6例）诊断为ESES的BECCT患儿临床表现及脑电图特点。患儿在口服LEV[20～40mg／（kg·d）]基础上联合2个月短程CZP，并随访6～18个月。结果15例患儿早期给予LEV单药治疗过程中复查EEG无改善或同时有癫痫发作，继而给予联合治疗（LEV＋短程CZP）；治疗后第1、6个月复查，14例患儿EEG放电明显减少（仅Rolandic区少量放电）或消失，发作完全控制，1例随访过程中ESES复发并癫瘸发作2次，重复上述联合治疗方案后第1、6个月复查，EEG正常范围，再次随访8个月无发作。结论LEV联合短程CZP对BECCT患儿ESES的控制相对理想、副作用少。

Objective To study the efficacy of levetiracetam （LEV） combined with short-term clonazepam （CZP） in the treatment of electrical status epilepticus during sleep （ESES） in children with benign childhood epilepsy with centrotemporal spikes （BECCT）. Methods Fifteen children （9 boys and 6 girls） diagnosed with BECCT with ESES, who had continuous spike-and-wave accounting for over 85% of the non-rapid eye movement sleep as monitored by 24-hours ambulatory EEG or 3-hours video EEG, were enrolled. The clinical manifestations and EEG characteristics of patients were retrospectively analyzed. These children received two months of CZP treatment in addition to oral LEV [20-40 mg/（kg＇d）]. All patients were followed up for 6-18 months. Results The 15 children were orally given LEV in the early stage, but showed no improvement when reexamined by EEG or had seizures during treatment. Then, they received LEV in combination with short-term CZP. Reexaminations at 1 and 6 months after treatment showed that 14 cases had significantly reduced discharge （only little discharge in the Rolandic area） or no discharge, as well as completely controlled seizure; one case had recurrent ESES and two epileptic seizures during follow-up. The recurrent case received the combination therapy again, and reexaminations 1 and 6 months later revealed normal EEG; no seizure occurred in the 8 months of follow-up. Conclusions LEV combined with short-term CZP is effective and has few side effects in treating ESES syndrome among children with BECCT.