儿童抗N-甲基-D-天冬氨酸受体脑炎的脑电图特征

Electroencephalographic features of anti-N-methyl-D-aspartate receptor encephalitis in children

目的探讨儿童抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的脑电图（EEG）特征。方法对2012年5月至2015年1月北京大学第一医院儿科神经病房确诊的28例抗NMDAR脑炎患儿临床资料进行回顾性分析，分析病程不同时期、不同轻重情况的EEG特点及转归。结果28例中男15例、女13例，起病年龄1岁3月龄至12岁4月龄。轻度组5例，重度组23例。在病程的不同时期，均有超过半数的EEG枕区背景保留，随着病情演变枕区背景及慢波逐渐恢复到正常。对疾病高峰期的EEG分析显示，轻度组（4／5）及重度组（9／17）病例仍有清醒期枕区背景保留，77％（17／22）病例出现非快速动眼（NREM）期d及0节律性图形。2例监测到8刷，其中1例混合在药物性快波背景中。71％（20／28）病程中EEG监测到癫痫样放电，其中6例继发了癫痫。结论儿童抗NMDAR脑炎的EEG清醒期背景活动及异常慢波均随病程演变并逐渐恢复；无论病情轻重，多数患儿在病程不同阶段枕区背景仍部分保留；NREM期出现α及θ频段节律较具特征性；8刷少见且判别易受药物性快波的干扰。EEG有癫痫样放电提示继发癫痫的可能性。

Objective To investigate electroencephalographic （EEG） characteristics of anti-N- methyl-D-aspartate receptor （anti-NMDAR） encephalitis in children. Method Clinical data of 28 children diagnosed as anti-NMDAR encephalitis were retrospectively analyzed for EEG characteristics in different periods and severity of disease and outcome. Result Among the 28 patients with anti-NMDAR encephalitis, 15 were males and 13 were females. Their age at disease onset ranged from 1 year 3 months to 12 years 4 months. Patients were divided into mild group （5 cases） and severe group （23 cases）. In the different stage of the disease, occipital background activity of the EEG was preserved in more than half of patients. Accompanied by the evolution of disease course, the occipital background activity and slow waves gradually recovered to normal. In the peak phase of disease, occipital background activity in the awake state was preserved in 4/5 patients of the mild group and 9/17 patients of the severe group. Alpha and theta band rhythms in non-rapid eye movement （ NREM ） sleep existed in 77% （ 17/22 ） patients. EEG monitoring showed delta brushes in 2 cases, and the delta brushes were mixed with background fast waves in one case; 71% （20/28） patients had epileptiform discharges in EEG during the course, and among them, 6 patients had secondary epilepsy. Conclusion The background activity in the awake state and abnormal diffuse slow waves of EEG were evolved and gradually recovered during the course of the disease. Regardless milder or severe illness condition, occipital background activity was still preserved during different stages in most patients. Alpha and theta rhythms in NREM sleep might represent a relatively overt EEG characteristic. The presence of delta brush in EEG was rare, and sometimes they were difficult to be distinguished from fast wave activities caused by drugs. The presence of epileptiform discharges in EEG suggested the possibility of secondary epilepsy.