儿童继发性癫痫的临床特点和诊治分析

SECONDARY EPILEPSY IN CHILDREN:CLINICAL CHARACTERISTICS,DIAGNOSIS AND TREATMENT

目的探讨儿童继发性癫痫的病因、起病年龄、临床特点、治疗方法和治疗效果。方法对2013年1月-2015年5月就诊我院的96例继发性癫痫病儿的临床特点和诊治情况进行回顾性分析。结果脑炎是儿童继发性癫痫常见的原因。颅脑外伤继发癫痫（PTE）多见于婴幼儿。发作类型以部分继发全面性发作常见（41%）。单药治疗的比例明显高于联合用药（χ2=10.801,P〈0.05）,尤以PTE组最高（χ~2=10.687,P〈0.05）。各组多以托吡酯（TPM）、左乙拉西坦（LEV）、丙戊酸（VPA）为主的单药或联合用药。脑发育异常继发癫痫组以LEV治疗多见（χ~2=7.479~8.889,P〈0.05）,脑炎继发癫痫组以VPA治疗多见（χ~2=7.083~8.333,P〈0.05）。PTE组疗效好于脑炎继发癫痫组（Z=-2.778,P〈0.05）。结论脑炎是儿童继发性癫痫常见的原因,PTE多见于婴幼儿,儿童继发癫痫以部分继发全面性发作多见。儿童继发性癫痫以单药治疗为主,PTE组单药治疗的比例明显高于其他组;脑发育异常继发癫痫多选用以LEV为主的单药或联合用药,脑炎继发癫痫则多选用VPA治疗;PTE的疗效好,而脑炎继发癫痫则疗效差。

Objective To explore the etiology,age of onset,clinical features,therapeutic methods and outcome in children with secondary epilepsy. Methods From January 2013 to May 2015,96 children with secondary epilepsy were treated in our hospital. Their clinical features,diagnosis and treatment were retrospectively reviewed. Results Encephalitis was a common cause of secondary epilepsy in children. Epilepsy secondary to traumatic brain injury was more common in infants and young children,its seizure type was mainly focal with secondarily generalized（ 41%）. The proportion of monotherapy was obviously higher than drug-combination one（ χ~2= 10. 801,P 〈 0.05）,in which,mostly seen in epilepsy secondary to traumatic brain injury（ χ~2= 10. 687,P 〈 0. 05）. Single or combined use of topiramate（ TPM）,levetiracetam（ LEV）,and valproate（ VPA） was give in the treatment of the disease. For the disease secondary to encephalodysplasia was mostly treated with LEV（ χ~2= 7. 083- 8. 333,P 〈 0. 05）. The therapeutic efficacy in epilepsy secondary to craniocerebral trauma was better than that in epilepsy due to encephalitis（ Z =- 2. 778,P 〈 0. 05）. Conclusion Encephalitis is a common cause leading to secondary epilepsy in children,and that secon-dary to craniocerebral trauma mostly seen in infants and young children,its seizure type was mainly focal with secondarily genera-lized. A single drug therapy is given priority to secondary epilepsy,its proportion being higher in those secondary to craniocerebral trauma than those with other reasons. For epilepsy caused by encephalodysplasia,levetiracetam was used- single or combined- for the therapy,for those due to encephalitis,valproate was mostly used. The therapeutic effectiveness in epilepsy secondary to traumatic brain injury was good,and that in secondary to encephalitis was poor.