儿童非惊厥性癫(癎)持续状态(NCSE)的临床与视频脑电图(VEEG)评估

Clinical and Video Electroencephalogram(VEEG) Assessment of Non-Convulsive Status Epilepticus(NCSE) in Children

目的:探讨儿童非惊厥性癫(癎)持续状态(NCSE)的临床与视频脑电图(VEEG)评估结果。方法:2018年1月~2019年1月,本研究入组儿童NCSE患者共30例,分析全部入选患儿的临床表现、脑电图、影像学、病因、治疗反应、预后等情况。具体包括以下:癫痫发作病史(发病年龄、发作方式、发病原因)、儿童NCSE的诱发原因、临床表现特征、VEEG检查特征、头颅CT报告或者MRI检查报告的特征。结果:①病因分析:30例患儿结合头颅CT或MRI检查结果,分析其原因包括如下:脑发育不完善15例,海马硬化5例,线粒体脑病6例,病毒性脑炎后遗症2例,结节性硬化1例,其他不明原因1例;②临床表现:30例患儿CPSE患者28例,AASE患者2例;首次发病患者10例,既往存在癫痫病史患者20例;单纯NCSE发作患者25例,GTCS激发NCSE患者5例。全部患儿均表现为不同程度的意识障碍,例如意识模糊、思维缓慢、健忘、记忆力降低、定向障碍等;其中3例伴随口腔或者肢体自动症,5例患者存在呆滞、反应差、眼神呆滞的症状(1例LennoxGastaut综合征,1例线粒体脑病,3例结节性硬化症);③脑电图特征:全部患者脑电图特征均表现为基本电活动变慢,20例一侧颞部起源癎性放电,10例伴随一侧慢波更多。结论:儿童NCSE的临床表现为意识、行为、性格、情绪的异常改变,伴随自动症、植物神经系统症状,可以通过VEEG对儿童NCSE进行诊断。

Objective:To investigate the clinical and video electroencephalogram(VEEG)evaluation results of non-convulsive epilepsy status(NCSE)in children.Methods:From January 2018 to January 2019,a total of 30 children with non-convulsive epilepsypersistent state(NCSE)were included in this study.The clinical manifestations,EEG,imaging,Etiology,response to treatment,and prognosis.Specifically include the following:history of epileptic seizures(age of onset,mode of onset,etiology),causes of non-convulsive epilepsy in children,clinical manifestations,features of VEEG examination,skull CT report or MRI Check the characteristics of the report.Results:(1)Etiological analysis:30 children combined with CT or MRI examinations of the head were analyzed for the following reasons:15 cases of imperfect brain development,5 cases of hippocampal sclerosis,6 cases of mitochondrial encephalopathy,and 2 cases of viral encephalitis sequelae Nodular sclerosis occurred in 1 case and other cases of unknown cause.(2)Clinical manifestations:28 patients with CPSE in 30 children and 2 patients with AASE;10 patients with first-onset disease and 20 patients with previous history of epilepsy;25 patients with simple NCSE attack and 5 patients with GTCSevoked NCSE.All children presented with varying degrees of consciousness disorders,such as blurred consciousness,slow thinking,forgetfulness,reduced memory,orientation disorders;3 of them had oral or limb autonomy,and 5 patients had sluggishness,poor response,and sluggish eyes.Symptoms(1 case of Lennox-Gastaut syndrome,1 case of mitochondrial encephalopathy,3 cases of tuberous sclerosis).(3)EEG features:The EEG features of all patients showed a slowdown of basic electrical activity,20 cases had a sacral discharge on one side and 10 cases were accompanied by a slow wave on one side.Conclusion:The clinical manifestations of children with non-convulsive status epilepsy(NCSE)are abnormal changes in consciousness,behavior,personality,and mood,accompanied by autonomic and autonomic nervous system symptoms.Children can be monitored by electroencephalography(VEEG)Non-convulsive epilepsy was diagnosed.