儿童局灶性发作发作期电-临床特征分析

Analysis of ictal electrical-clinical characteristics of focal seizures in children with epilepsy

目的探讨儿童期局灶性发作发作期电-临床特征。方法以2017 年1 月至2018 年6 月确诊的257 例局灶性发作共409 次患儿为受试者,结合头部影像学资料分析视频脑电图特征。结果发作期症状主要表现为双眼斜凝视(202 次)、偏转(142 次)、不对称性强直(138 次)、口角歪斜(45 次)、单个或一侧肢体强直-阵挛(42 次)、感觉异常(32 次)、自主神经症状(92 次)、过度运动(93 次),以及手、口自动症行为(92 次)、发声(68 次)和局灶性失张力(6 次)、局灶性肌阵挛(4 次)、局灶性强直(2 次),以上症状以单一或组合方式出现。视频脑电图监测,发作类型呈局灶性发作(249 次)、局灶继发双侧强直-阵挛发作(121 次)、局灶性发作持续状态(29 次)、局灶性发作伴痉挛(10 次);发作期脑电初始模式分别表现为脑区性(188 次)、局灶性(55 次)、一侧大脑半球(53 次)、非一侧性(71 次)或无法确定(42 次);发作间期脑电活动则呈局灶性放电(92 例)、多灶性放电(49 例)、广泛性放电(27 例)或无放电(89 例)。257 例中178例(69.26%)归类于癫综合征,其中年龄相关性癫综合征以良性家族性或非家族性婴儿惊厥为主占54.26%(51/94 例),而部位相关性癫则以额叶癫更高发占62.50%(50/80 例)。结论儿童局灶性发作发作期症状具有局灶性特征,发作期初始脑电模式呈多样性,可与多种癫综合征相伴发,视频脑电图监测是目前明确诊断不可替代的方法。

Objective To explore the ictal electrical-clinical features of focal seizures in childhood with epilepsy. Methods The video electroencephalography (VEEG) results of 409 focal seizures of 257 patients with epilepsy during January 2017 to June 2018 in EEG Monitoring Center of Department of Neurology of Hu'nan Children's Hospital, along with their neuroimage results were retrospectively analyzed. Results The main symptoms during the attack period were binocular gaze (202 times), deflection (142 times), asymmetrical tonic (138 times), distortion of mouth (45 times), single or one side limb tonic clonic (42 times), focal abnormal sensation (32 times), autonomic neurological symptoms (92 times), hyperkinetic automatisms (93 times), and hand and/or mouth automatism (92 times), vocalization (68 times) and focal atonia (6 times), focal myoclonus (4 times), and focal tonic (2 times). The above symptoms appeared in a single or combined way. VEEG monitoring showed that the types of seizures were focal seizures (249 times), focal to bilateral tonic clonic seizures (121 times), focal status epilepticus (29 times), and focal seizures with spasm (10 times). Initial pattern of EEG during seizure: regional (188 times), focal (55 times), unilateral (53 times), non-unilateral (71 times ) or uncertain (42 times). Inter?episodic EEG activity showed focal discharge (92 cases), multifocal discharge (49 cases), extensive discharge (27 cases) or no discharge (89 cases). In 257 cases, 178 cases (69.26%) were classified as epilepsy syndrome. Benign familial or non-familial infantile seizures was more common (54.26%, 51/94) in the group of age?dependent epilepsy syndrome, frontal lobe epilepsy was more common (62.50%, 50/80) in location related epilepsy. Conclusions The seizure symptoms of focal seizures in children have focal features, and the ictal EEG patterns during the seizure are diverse, which can be associated with multiple epilepsy syndromes. VEEG monitoring is an irreplaceable method for definite diagnosis at present.