癎性喉肌痉挛发作的临床及电生理研究

The electroclinical aspect of patients with epileptic spasm in laryngeal muscles

目的：研究癫痫性喉肌痉挛发作的临床及电生理特点。方法：对本院脑电图监测中心经治的2例表现为痫性喉肌痉挛发作的癫痫患者的临床和电生理特点进行研究。结果：例1为23岁女性，例2为3岁患儿，这两位患者主要表现均为发作性尖叫，在外院均曾多次被误为内科急症，给予内科相关处理，效果不佳。后辗转至我院就诊，行长程脑电图监测发现发作期同步脑电图均可见到各导棘慢、多棘慢综合波发放，同步肌电图显示对应于慢波成分呈现快速增强快速减弱的“菱形”表现。且2例患者经抗癫痫药物治疗后上述发作显著减少。结论：喉肌痉挛属于内科急症，如处理不当会危及患者的生命。非痫性喉肌痉挛常见于低钙血症、过敏、急性上呼吸道感染或喉部操作（如气管插管、喉部手术）等，以上情况已经为内科医生所熟知。通过本文的2例癫痫性喉肌痉挛的报道，以期使临床医生认识到喉肌痉挛可以是非痫性的病因引起，也可以是一种特殊的癫痫发作形式，需通过仔细询问病史，结合相关检查，尽快明确病因，以免误诊误治。

Objective：To explore the clinical and electrophysiological feature of epileptic spasms in laryngeal muscles. Methods： Two patients with laryngospasm epileptic seizures were admitted to EEG monitoring center,and their clinical and electrophysiological features were analyzed. Results：The 2 cases 23-year-old woman and a 3 year-old child with paroxysmal screaming were involved in the study. They were both misdiagnosed as medical emergency in other hospitals and given ineffective medical treatment. After the treatment in our hospital,synchron0us long-term video EEG monitoring found that the two ca- ses suffered from epileptic seizures with guide spike slow, multi-spike slow wave distribution and syn- chronous EMG showed slow wave component corresponding to ＂diamond＂ presentation of rapid weake- ning rapidly and rapid increasing. After antiepileptic drug therapy the onsets of the above two cases were significantly reduced. Conclusion： Laryngeal spasm belongs to medical emergency,misdiagnosis would en- danger the lives of patients. Non-epileptic laryngeal spasm is common in hypocalcemia, allergy, acute up- per respiratory infection or throat operations （such as endotracheal intubation, laryngeal surgery）. The a- hove features are well known to physicians. Through this article about the two cases of epilepsy laryngeal spasm, clinicians are expected to realize laryngeal spasm may be caused by non-epileptic diseases. It can be a special kind of seizures and it is necessary to inquire the detailed disease history,carryout careful rele- vant make sure of the cause,in order to avoid misdiagnosis and mistreatment.