新生儿期一次发作事件中癫痫性痉挛与局灶性发作共存15例临床分析

Clinical analysis of 15 patients with epileptic spasms and focal seizures as a single ictal event in neonatal period

目的探讨新生儿期出现的一次发作事件中癫痫性痉挛发作(ES)与局灶性发作(FS)共存(FS-ES现象)的临床特点、病因及预后。方法回顾性分析2018年1月至2019年12月在复旦大学附属儿科医院新生儿科住院的经过视频脑电图(VEEG)明确存在FS-ES现象的15例新生儿的病例资料。结果15例新生儿中男7例、女8例;出生胎龄为39(32~42)周,出生体重3100(1825~3850)g;首次发生惊厥的年龄为2(1~10)日龄;首次发现FS-ES现象为25(14~32)日龄;惊厥停止年龄7(1~27)月龄。所有患儿首次惊厥的类型均为局灶性发作。15例患儿的FS-ES现象均以FS起始,12例ES紧随FS之后,2例ES存在于FS过程中,1例2种形式均有出现。病因有遗传因素(9例)、颅内感染(1例)、脑结构异常(2例),另还有3例原因不明。除1例患儿预后良好外,其余患儿均预后不良。结论新生儿期出现FS-ES现象时均以FS起始,病因多样,遗传因素占多数,预后多数不良。

Objective To investigate the phenomenon of epileptic spasms(ES)and focal seizures(FS)in a single ictal event(FS-ES phenomenon)and to study the etiology,manifestations,and prognosis of this phenomenon.Methods The data of the 15 neonates who had ES and FS in a single ictal event,according to video-electroencephalography(VEEG)recording in Department of Neonatology of Children′s Hospital of Fudan University during the period of January 2018 to December 2019,was analyzed retrospectively.Results Of the 15 neonates,7 were male and 8 were female.Gestational age was 39(32-42)weeks.Birth weight was 3100(1825-3850)g.The initial onset age of convulsions was 2(1-10)days.The age of the first discovery of FS-ES phenomenon was 25(14-32)days.The age of seizure-free was 7(1-27)months.All of the initial seizure types were FS.The FS-ES phenomenon of 15 patients started with FS.The FS-ES phenomenon manifested in 2 forms:FS followed by ES(12 cases),ES appeared during an FS without interrupting FS(2 cases).In 1 neonate the spasm occurred in both forms.The etiology included genetic factors(9 cases),intracranial infection(1 case),abnormal brain tissue structure(2 cases),and etiology was unknown in 3 cases.All the neonates had a poor prognosis except one.Conclusions The FS-ES phenomenon in the neonatal period starts with FS.There are various etiologies.Etiologies of most patients are genetic factors.Most of the patients have a poor prognosis.