22例轻度胃肠炎伴婴幼儿良性惊厥的临床分析

A Clinical Study of 22 cases of Benign Infantile Convulsion with Mild Gastroenteristis

目的:研究轻度胃肠炎伴婴幼儿良性惊厥(Benign infantile convulsions with mild gastroenteritis,BICE)的临床特点及发病机制,以提高临床医师对此病的认识。方法:分析22例轻度胃肠炎伴婴幼儿良性惊厥患儿的临床资料。结果:(1)临床特征:22例患儿惊厥前均有腹泻、呕吐等胃肠炎表现,部分患者伴低热;77.3%患者惊厥出现在病程的前2 d内,100%患者惊厥发生在病程4 d内;95.5%患者惊厥的表现形式为全身强直—阵挛发作,全面性+部分性发作1例,1个病程发作1~10次不等。(2)大便检测:所有患者均做大便常规镜检,均未见红细胞及白细胞,17例患者行轮状病毒检测,11.8%(2/17)患者轮状病毒抗原阳性。(3)血液检:15例患者肌酸激酶同工酶(CK-MB)轻度升高(小于99 U/L),肝肾功、电解质、血糖均正常;6例患者行腰椎穿刺术,脑脊液常规、生化及脑压均无异常。(4)头颅影像学(头颅CT或头颅MRI)及脑电图:20例患者行头颅影像学检查,均正常;5例患儿脑电图轻微异常,表现为非特异性的慢波,棘慢波发放。(5)随访:15例患者出院后随访6~12个月,均无惊厥发作,智力运动发育正常,脑电图正常,7例患者失访。结论:本组患者具有以下特点:轻度胃肠炎伴婴幼儿良性惊厥发病年龄主要在1~2岁,秋季高发,惊厥为全面强直—阵挛发作为主,虽然个别患者发作次数多,但均复发率低,不需长期抗癫痫治疗,预后良好。

Objective： To improve the clinicians ’ awareness about benign infantile convulsions associ-ated with mild gastroenteritis through studying its clinical features and pathogenesis. Methods ： To analyze the clinical data of 22 pediatric patients suffering BICE. Results： （ 1 ） Clinical features： （T）A11 patients had diar-rhea ,vomiting and other gastroenteric complaints before convulsions, and some of them had mild fever.②The seizure ： seizures occured in 77. 3% （17/22） patients in the first 2 days , and in all of them did in the first 4 days during one course. Generalized tonic - clonic seizures occured 1-10 times in 21 patients （95. 5% , 21/22） , and only one patient suffered generalized and focal seizures. （2） Stool detection ; All patients went through routine test in which red blood cells and white blood cells were not found. Rotavirus was detected in 17 patients, and 11. 8% （2/17） patients were positive for rotavirus antigen. Blood samples testing; In 15 cases, their creatine kinase isoenzyme （CK - MB） increased slightly （ less than 9 9U /L ） , but liver function,kidney function, electrolyte and blood glucose were normal. Six patients received lumbar puncture examina tion. and heir cerebro - spinal fluid routine, biochemical and cerebral pressure were normal. （3） Head ima-ging examination including skull computed tomography （ CT） or head magnetic resonance imaging （MRI） for 20 cases were all normal. Five cases were slight abnormal in electroencephalogram （ EEG） , which showed nonspecific slow waveor spike slow wave. （4） Follow up： Contact with seven patients were lost after their be-ing discharged from hospital. Fifteen patients were followed up 6 - 12 months and no seizure occured again. Their intelligence motor development and EEG were normal. Conclusion： Patients in our study were manief- sted with the following characteristics ： The highest incidence of BICE is in autumn and the age is from 1 to 2 years old. The convulsions are mainly tonic - clonic seizures, which attack frequently in some patients, but the recurrence rate is low. So long - term antiepileptic treatment is typically not required, and BICE has a better prognosis