212例初诊癫痫患儿的院外与院内诊断及用药分析

Out-of-hospital and In-hospital Diagnosis and Medication of 212 Children with Newly-diagnosed Epilepsy

目的通过分析212例郑州大学第三附属医院初诊癫痫患儿的院内与河南省各基层医院的诊断及用药,探索河南省各基层医院对癫痫的诊断及用药水平。方法收集2018年12月至2019年2月在郑州大学第三附属医院小儿神经内科初次诊断为癫痫的患儿资料,遵循最新的癫痫诊断及治疗方案进行分析。结果212例患儿经河南省各基层医院全部诊断为癫痫,但未对其进行分型诊断。后经郑州大学第三附属医院诊断,确诊癫痫综合征59例,153例未归为癫痫综合征。153例中全面性发作68例(44.44%),局灶性发作78例(50.98%),起始不明发作7例(4.58%);病因遗传性10例(6.54%),结构性53例(34.64%),感染性2例(1.31%),代谢性2例(1.31%),免疫性1例(0.65%),未知病因85例(55.56%)。212例患儿在河南省各基层医院共117例(55.19%)未用药,48例(22.64%)单药治疗,23例(10.85%)二联用药,23例(10.85%)三联及以上用药,1例用药不详(0.47%)。后经郑州大学第三附属医院调整治疗方案后,22例(10.38%)未用药,单药治疗为121例(57.08%),二联用药43例(20.28%),三联及以上用药26例(12.26%)。结论癫痫发病机制复杂,癫痫的诊断及分型存在很大困难。在所有癫痫患儿中大多数未归为癫痫综合征,其中以局灶性发作为主,对癫痫患儿的用药均以单一用药为主。河南省各基层医院与郑州大学第三附属医院对癫痫患儿的诊断的正确率很高,但河南省各基层医院在分型诊断上有所不足,且未用药率较高。

Objective By analyzing the diagnosis and medication of 212 children with epilepsy newly diagnosed in the Third Affiliated Hospital of Zhengzhou University and primary hospitals in Henan Province,this paper explores the diagnosis and medication level of epilepsy in primary hospitals of Henan Province.Methods The children who were newly diagnosed with epilepsy in the Department of Paediatric Neurology of the Third Affiliated Hospital of Zhengzhou University from December 2018 to February 2019 were analyzed based on the latest epilepsy diagnosis and treatment plan for analysis.Results All 212 children were diagnosed as epilepsy by primary hospitals in Henan Province,but no classification was made.After diagnosis in the Third Affiliated Hospital of Zhengzhou University,59 cases of epilepsy syndrome were confirmed,and 153 cases were not classified as epilepsy syndrome.In 153 cases,68 cases(44.44%)had comprehensive seizures,78 cases(50.98%)had focal seizures,and 7 cases(4.58%)had unknown onset.There were 10 cases(6.54%)of heredity,53 cases(34.64%)of structure,2 cases(1.31%)of infectivity,2 cases(1.31%)of metabolism,1 case(1.65%)of immunity,and 85 cases(55.56%)of unknown etiology.One hundred and seventeen of 212 cases(55.19%)were not treated with drugs in primary hospitals of Henan Province,including 48 cases(22.64%)treated with single drug,23 cases(10.85%)treated with double drug,23 cases(10.83%)treated with triple drug or more,1 case(0.47%)was unknow.After adjusting the treatment plan in the Third Affiliated Hospital of Zhengzhou University,22 cases(10.38%)were not treated with drugs,121 cases(57.08%)were treated with single drug,43 cases(20.28%)with double drug,and 26 cases(12.26%)with triple drug or more.Conclusion Due to the complex pathogenesis of epilepsy,the diagnosis and classification of epilepsy is very difficult.Most of the children with epilepsy were not classified as epileptic syndrome,and the majority of them were focal seizures,single drug was used in children with epilepsy.Primary hospitals in Henan Province and the Third Affiliated Hospital of Zhengzhou University have a high accuracy rate in diagnosing children with epilepsy,but primary hospitals in Henan Province are not enough in the classification diagnosis,and the rate of not using drugs is high.