视频脑电图对1岁内婴儿非惊厥性发作的诊断及鉴别诊断价值

The diagnostic and differential diagnostic value of video electroencephalography in infants less than 1-year-old with non-conclusion seizures

目的：探讨1岁以内婴儿非惊厥性发作（non-conclusion seizures,NCS）的临床特征及视频脑电图（video electroencephalography,VEEG）对其的诊断及鉴别诊断价值。方法对30例 NCS 患儿在 VEEG 监测时先行20 min 清醒常规脑电图检查,然后继续监测2～4 h 记录醒-睡眠-觉醒 VEEG,将二者进行对比分析,同时1、2、3个月后分别随访患儿的 NCS 发作情况。结果常规脑电图监测期间3例（10.0%）出现发作事件,VEEG 监测23例（76.7%）出现发作事件,VEEG 监测儿童发作事件阳性率高于常规脑电图（P ﹤0.01）。30例患儿临床症状均为躯体性发作 NCS,无心因性发作,其中表现为非癫痫性强直发作者19例（63.3%）,包括双眼凝视2例,咬牙或用力咧嘴2例,头后仰1例,伸颈或缩颈1例,耸肩2例,摇头晃头9例,全身用力或僵直、抖动、面色发红2例；表现为良性肌阵挛者7例（23.3%）,良性非癫痫性婴儿痉挛者4例（13.3%）；未见其他类型 NCS 发作。所有患儿均未进行抗癫痫药物治疗,15例患儿随访1个月内发作事件趋于消失,7例2个月后消失,1例患儿随访3个月消失,另有7例患儿3个月后发作次数明显减少,仅在高兴、生气或情绪激动时偶有发作。结论 VEEG 对1岁内婴儿 NCS 的诊断及鉴别诊断具有重要作用,同时对监测 NCS 病情进展也有重要价值。

Objective To discuss the clinical features of non-conclusion seizures（NCS）in infants less than 1 -year-old,and the diagnostic and differential diagnostic value of video electroencephalography （VEEG）.Methods A total of 30 NCS patients were took the regular electroencephalography at the first 20 minutes before VEEG monitoring which continued 2 to 4 hours in order to compare the differences between the two monitoring methods,then all patients were taken follow-up after one month,two months,and three months.Results Three cases attacks（accounting for 10.0%）were found by regular electroencephalograph-y,while 23 attacks（accounting for 76.7%）were found by VEEG following no epileptic discharge,either.All patients were found to be corporality NCS,having no psychogenic NCS,among which,19 patients（accounting for 63.3%）were non epileptic tonic-closure seizures,including 2 patients always keeping eyes staring at somewhere,2 patients gritted teeth or grinned,1 patient often put head back,1 patient stretched the neck or necking down,2 patients shrug his shoulders,9 patients shook head,and another 2 always put forth his strength, with or without stiffness,limb jitter,or made face red;on the other,7 patients （accounting for 23.3%）were benign myoclonus,another 4（accounting for 13.3%）were benign non epileptic infant spasm,no other types were found.Nobody had any antiepileptic therapies,15 of them have no more attacks in less than one month,7 in two months,1 in three months,and another 7 appeared occasionly under the conditions of great happiness,extreme anger or been raged.Conclusion VEEG have irreplaceable diagnostic and differential diagnostic value in infants less than 1 -year-old with NCS,and play an important role in monitoring the development of NCS.