儿童额叶癫痫临床和长程视频脑电图特征

Clinical and long-term video EEG features of children with frontal lobe epilepsy

目的通过对46例儿童额叶癫痫患儿的临床表现、长程视频脑电图(VEEG)特点进行分析,提高对儿童额叶癫痫的认识。方法收集2008年12月至2014年8月儿科门诊及住院确诊的46例儿童额叶癫痫病例的资料,回顾性分析其临床表现、VEEG及神经影像学等特征。结果本组患儿发病年龄最小1 1个月,最大15岁。46例患儿共监测到临床发作258次,明确临床发作34例,14.7%仅于清醒期发作,61.8%仅在睡眠期发作,23.5%在清醒、睡眠中均有发作;临床发作形式包括额叶失神、局部阵挛发作、偏转性强直、姿势性强直、过度运动性自动症、口咽自动症、发声、发笑发作、临床下放电和自主神经性发作等。73.9%息儿记录到发作间期额叶为主的癫痫样放电,63.0%患儿记录到发作期额叶为主的癫痫样放电。结论儿童额叶癫痫临床发作频繁、短暂,以睡眠期发作为主,临床表现复杂多样,易漏诊;长程VEEG可监测到儿童额叶癫痫发作期临床及异常脑电图表现,可提供明确诊断率。

Objective To analyze the clinical and long-term video EEG （VEEG） features of children with frontal lobe epilepsy. Methods Forty six children with frontal lobe epilepsy were admitted in Hangzhou First People＇s Hospital from December 2008 to August 2014. The clinical manifestations, neurological imaging and long-term VEEG findings were retrospectively analyzed. Results The age at the onset of these patients was from 11 months to 15 years. The clinical seizure types included frontal lobe absences, focal clonic seizures, version seizures, postural-tonic seizures, somato-automatisms, sounding, gelastic seizures, feeling abnormality, autonomic seizures, etc. Among 46 patients, interictal EEG discharges mainly located in the frontal lobe were recorded in 73.9% patients, the abnormal rhythm changes in frontal lobe were recorded in 63.0% patients. 73.9%（34/46） clinical seizures were captured by video monitoring, 14.7% only attacked when awake, 61.8% only attacked when sleep, 23.5% attacked when awake and sleep, 285 times of clinical seizures were captured by video monitoring, the abnormal discharges mainly originated in unilateral and/or bilateral frontal region were recorded in 66.3% patients. Conclusion Frontal lobe epilepsy in children is a syndrome with extremely complex and diverse clinical manifestations, long-term video EEG can monitor the interictal clinical manifestations and abnormal EEG discharges in children with frontal lobe epilepsy.