儿童额叶惊恐发作癫痫的长期临床治疗追踪

Long-term clinical featment of children with ictal fear in frontal lobe epilepsy

目的：回顾性分析儿童额叶惊恐发作癫痫的临床特征及对奥卡西平（OXC）或卡马西平（CBZ）单药治疗的反应，总结其临床特点及疗效。方法：收集2009～2013年我院门诊及住院病人，以惊恐发作为主临床症状，结合发作间期及发作期的视频脑电图（V—EEG），诊断为额叶惊恐发作癫痫的患儿43例，其中资料完整者39例，随访时间为2．6～4年，分析其临床特点及对OXC或CBZ的治疗的反应及长期疗效。结果：39例患儿，年龄2岁零8个月～11岁零7个月，惊恐发作为主症状，平均每天发作13．8次。头颅MR36例正常，2例脑白质髓鞘发育稍落后，1例脑沟加深。V-EEG37例提示发作期额区放电。33例首选单药OXC或CBZ，9例服药第1天起无发作，OXC用量平均为15．8mg／kg，CBZ为11．5mg／kg。长期无发作25例（76％）（在服药第1天或2周起无临床发作）。结论：以惊恐发作为主症状的儿童额叶癫痫，首选OXC或CBZ单药治疗疗效显著，起效快，且低剂量可维持高的长期无发作状态。

Objective： To make retrospective analysis of clinical characters of ictal fear in children with frontal lobe epilepsy,and summarize the drug responsiveness and treatment effect of oxcarbazepine （OXC）or carbamazepine（CBZ） monotherapy for ictal fear in frontal lobe epilepsy. Methods： Pediatric patients with ictal fear as the main feature in our clinic and inpatient department between January 2009 and December 2013 were involved in the stydy. 43 children were diagnosed as ictal fear in frontal lobe epilepsy based on interictal and ictal video electroencephalogram （VEEG）. Among them 39 had sufficient infor- moation. Follow-up period was 2.6-4years. The clinical characters of ictal fear in frontal lobe epilepsy and long-term dficacy of OXC / CBZ monotherapy were analyzed retrospctively. Results： 39 patients aged 2. 8411.7years with ictal fear as the main symptom were involved. The frequency of average ictal fear onset occured 13.8 per day（ The cranial MRI of 36 cases was normal, delayed white matter myelination was found in 2 case,deeped sulcus was in one case,V-EEG of 37 cases showed ictal frontal onset. Out of 33 patients who took OXC or CBZ at first, 9 cases had no seizure since the first day and 25 cases（76 %） suffered from long-term seizure. The average dose of OXC was 15. 8 mg/kg ~ d or that of CBZ was 11.5 mg/kg d, Conclusion：OXC or CBZ monotherapy in children with ictal fear in frontal lobe epilepsy is the first choice of therapy. Its treatment effect is distinct and obvious. Low dose can maintain long-term seizure free.