影响儿童颞叶癫痫伴海马硬化药物治疗效果的相关因素分析

Clinical Analysis of Temporal Lobe Epilepsy with Hippocampal Sclerosis in Children

目的:探讨影响儿童颞叶癫痫伴海马硬化(TLE-HS)的临床药物疗效的相关因素。方法:40例TLEHS患儿,均行抗癫痫药物治疗,记录患儿性别、发病年龄、病程、热性惊厥史、发作频率、发作类型、海马影像学特征及脑电图,观察患儿抗癫痫药物疗效果,并对差异有统计学意义的参数进行多因素Logistic回归分析,了解这些参数与治疗效果的关系。结果:TLE-HS患儿男女比为1.353∶1,发病年龄以3~6岁为主(45.0%);头颅MRI检测海马异常的阳性率为75.0%,MRS检查海马异常的阳性率为90.0%,85.0%患儿脑电图有痫样放电;Logistic回归分析提示癫痫发作频率高可能是影响药物治疗效果的危险因素(P<0.05,OR=17.46),单药治疗反应好是影响药物治疗效果的保护因素(P<0.05,OR=0.06)。结论:发作频率高的TLE-HS患儿药物治疗效果不佳,单药治疗反应好患儿的预后良好。

Objective： To summarize the clinical features of temporal lobe epilepsy with hippocampal sclerosis in children,and explore its correlated factors of the impact of drug efficacy for the clinical diagnosis,treatment and prognosis. Methods： The sex,age of onset,disease duration,history of febrile seizures,seizure types,cranial magnetic resonance,electroencephalogram and drug treatment of 40 cases were respectively analyzed. According to the efficacy of antiepileptic drugs（ AEDs）,the patients were divided into the effective group and the ineffective group. The logistics regression analysis of factors related to curative effects was performed. Results： The ratio of male to female in TLE-HS was 1. 353∶ 1,and the age of onset was mainly 3 - 6 years old（ 45%）. The positive rate of hippocampal abnormalities detected by cranial MRI was 75%,and the positive rate of MRS examination was 90%.V-EEG： epilepstic discharge was confirmed in 34 cases（ 85. 0%）. Logistic regression analysis suggested that the high frequency of epileptic seizures may be a risk factor affecting the effect of drug treatment（ P〈0. 05,OR = 17. 46）. The good response of single drug therapy is a protective factor affecting the effect of drug treatment（ P〈0. 05,OR = 0. 06）. Conclusions： TLE-HS children with high seizure frequency have poor curative effects. The prognosis of children with good response to single drug therapy is rather good.