新生儿惊厥临床及视频脑电图特点分析

Clinical presentation and video EEG characteristics of neonatal seizures

目的分析新生儿惊厥的发病原因及数字化视频脑电图(VEEG)的特点。方法选择2010年7月至2015年2月我院新生儿病房住院诊断为新生儿惊厥并进行了VEEG检查的患儿为研究对象,回顾性记录患儿临床资料,包括起病日龄、发作形式及VEEG结果,根据病史和辅助检查判断惊厥原因。结果共收录新生儿惊厥48例,均为反复惊厥发作,足月儿占89.6%,生后72 h内起病35例(72.9%),7天内起病占79.2%。病因明确27例(56.2%),病因不明21例(43.8%)。在已明确的病因中以围产期脑损伤(59.3%)为主,其次为先天性脑发育异常(18.5%)和代谢紊乱(14.8%)。发作形式以单一发作为主(37例,占77.1%),发作形式前三位分别为微小型发作、多灶性阵挛型发作和强直型发作;复合发作(表现为两种及以上发作形式)11例(22.9%),以微小型发作伴多灶性阵挛型为主。48例患儿VEEG检查正常1例,异常47例,其中轻度异常18例(38.3%),中度异常21例(44.7%),重度异常8例(17.0%);VEEG以单一异常为主(34例,72.3%),包括阵发性异常17例,成熟性异常12例,背景活动异常5例;复合异常(两种以上异常)13例,以成熟性异常伴阵发性异常为主。48例患儿在做VEEG检查时发现癫疒间性发作15例(31.2%),非癫疒间性发作22例(45.8%),无发作11例(22.9%)。结论新生儿惊厥多发生在生后1周之内,以围产期脑损伤为主要病因,VEEG多为轻中度异常。VEEG检查有助于鉴别新生儿惊厥和非惊厥性发作。

Objective To study the etiology video electroencephalogram （ V-EEG）. Methods of neonatal seizures and the characteristics of digital From July 2010 to February 2015, neonates with clinical seizures were admitted to the neonatal ward of Peking University First Hospital, and consecutively received V-EEG monitoring. Their general profile, onset time of seizure, etiology, seizure types and V-EEG activity were obtained. Results A total of 48 neonates with seizures were enrolled in this study, with 89. 6% full-term neonates. 35 neonates （72.9%） developed seizure within 72 hours after birth, and 79.2% within 7 days. Etiologies were identified in 27 patients （56.2%）, and 21 cases （43.8%） unknown. Among etiologies, brain damage （59.3%） was the main cause of the disease, secondly cerebral malformation （18.5%）. Most patients had one single seizure type （37 cases, 77.1% ）. Subtle, multifocal clonic and tonic seizures were the most frequently observed types. 11 patients （22.9%） had multiple seizure types, such as subtle seizures mixed with muhifocal clonic seizures.Among the 48 neonates, 47 had abnormal V-EEG activity, including 18 mild cases （38.3%）, 21 moderate cases （44.7%） and 8 severe cases （ 17.0% ）. Single abnormality （34 cases, 72.3% ） was the main pattern of abnormal V-EEG activity, including 17 patients with paroxysmal activities, 12 disordered maturation and 5 abnormal background activity. 13 patients had complex abnormalities （more than two patterns）, most commonly disordered maturation with paroxysmal activities. 15 patients （31.2%） presented epileptic seizures during V-EEG monitoring, and 22 （45.8%） non-epileptic seizures. Conclusions Neonatal seizures often develop within the first week of life , with perinatal brain injury as the leading cause. Paroxysmal activities and disordered maturation are main patterns of abnormal neonatal V-EEG activity. V-EEG plays important role for the diagnosis of epileptic seizures and non-epileptic seizures.