婴儿痉挛症经ACTH治疗发作控制后脑电图对于复发的预测价值

Predictive Value of EEG Findings at Control of Infantile Spasms forSeizure Relapse after Adrenocorticotropic Hormone Therapy

目的评价经促肾上腺皮质激素(ACTH)治疗的婴儿痉挛症患儿,发作控制以后脑电图对复发的预测价值。方法收集婴儿痉挛症患儿50例,回顾性分析患儿的临床资料并进行随访研究。患儿接受初始ACTH治疗后,发作均得到控制。根据发作控制1月左右的视频脑电图结果,将患儿分为3组,即正常组(无癫痫波,n=11)、不正常组(有癫痫波但无高度失律,n=33)及高度失律组(n=6),比较3组的复发率。结果经过1~5年的随访,50例中,癫痫复发22例(44%),其中癫痫性痉挛18例,局灶性发作4例。复发与治疗后脑电图密切相关,脑电图正常组、不正常组及高度失律组的复发率分别为9.1%,48.5%及83.3%,3组间差别均有统计学意义(P<0.05)。结论婴儿痉挛症患儿经过初始ACTH治疗发作控制后,其脑电图对癫痫复发有较好的预测价值。

Objective To evaluate the predictive value of electroencephalography(EEG)findings at cessation of infantile spasms for seizure relapse after adrenocorticotropic hormone(ACTH)therapy.Methods We reviewed 50 children with infantile spasms who had obtained control of epileptic spasms with initial treatment of ACTH.These patients were followed up for 1~5 years.According to the EEG findings at control of infantile spasms at about 1 month after ACTH therapy,the subjects were divided into three groups:normal group(no epileptic activity,n=11),abnormal group(residual epileptic activity without hypsarrhythmia,n=33),and hypsarrhythmic group(persisting hypsarrhythmia,n=6),then we compared the relapse rate of the three groups.Results Overall,22(44%)of the 50 patients had experienced relapses of seizures(epileptic spasms 18 and focal seizure 4)after initial control of epileptic spasms.Seizure relapse rate was correlated to the EEG findings at control of epileptic spasms.The normal group had a significantly lower seizure relapse rate(9.1%)in comparison with the abnormal group(48.5%)and the hypsarrhythmic group(83.3%).There were significant differences among these three groups(P<0.05).Conclusion This study demonstrated that EEG findings after ACTH therapy in patients with infantile spasms are significantly related to seizure relapse.