睡眠中癫痫性电持续状态的脑电诊断及临床治疗

EEG Diagnosis and Clinical Treatment of Electrical Status Epilepticus during Sleep

目的探讨睡眠中癫痫性电持续状态(electrical status epilepticus during sleep,ESES)的脑电诊断及临床治疗。方法脑电图棘慢波指数(SWI)≥50%并完成治疗的癫痫患儿30例(A组16例:50%≤SWI<85%;B组14例:SWI≥85%),按就诊顺序随机分为C、D 2组,每组15例,行不同疗程(C组6个月,D组12个月)激素治疗,治疗前后均进行神经心理损伤评估,并随访治疗后的疗效及不良反应。结果 A、B 2组治疗前均有程度不一的神经心理损伤,言语智商(VIQ)、操作智商(PIQ)及总智商(FIQ)均较正常值低,以VIQ下降最显著,B组VIQ和FIQ较A组低,差异有统计学意义(P<0.05);C、D组VIQ、FIQ较激素治疗前均有增高(P<0.05),其中ESES消失者VIQ、FIQ明显高于治疗前(P<0.05),但C、D 2组间神经心理损伤改善程度及总有效率比较差异无统计学意义(P>0.05);D组不良反应大于C组(P<0.05)。结论 SWI≥50%定为ESES的脑电诊断标准有助于ESES的合理诊断,早期干预;激素治疗ESES安全有效,疗程6个月更合理。

ABSTRACT:Objective To investigate the EEG diagnosis and clinical treatment of electrical sta-tus epilepticus during sleep(ESES).Methods According to the spike-wave index(SWI),30 chil-dren with epilepsy were divided into group A(50% ≤ SWI< 85%,n= 16)and group B(SWI≥85%,n=14).According to the visiting sequence,these children were divided into group C(hor-mone treatment for 6 months,n= 15)and group D(hormone treatment for 12 months,n= 15). Neuropsychological impairment was assessed before and after treatment.In addition,the efficacy and adverse reactions were observed after treatment.Results Both group A and group B had dif-ferent degrees of neuropsychological impairment and lower verbal intelligence quotient(VIQ), performance intelligence quotient(PIQ)and full intelligence quotient(FIQ)before treatment.A-mong these indicators,VIQ decreased most significantly.Compared with group A,both VIQ and FIQ significantly decreased in group B(P <0.05).In both group C and group D,VIQ and FIQ in-creased after hormone treatment,especially in children with the disappearance of ESES (P <0.05).Compared with group C,adverse reactions significantly increased in group D(P <0.05). However,no significant differences in the improvement in neuropsychological impairment and o-verall response rate between the two groups(P >0.05).Conclusion The criterion of SWI≥50%contributes to the reasonable diagnosis and early intervention of ESES.Hormone treatment for 6&nbsp;months is effective and reasonable for ESES.