甲状旁腺功能减退症误诊为癫痫22例临床资料分析

Clinical analysis of 22 cases with hypoparathyroidism misdiagnosed as epilepsy

背景甲状旁腺功能减退症(hypoparathyroidism,HP)患者因低血钙导致神经肌肉兴奋性增高,临床表现为手足反复搐搦发作等,容易被误诊为原发性癫痫而接受抗癫痫药物治疗。目的回顾分析HP误诊为癫痫的临床病例资料,为降低误诊误治率总结经验及教训。方法收集2008年1月1日-2021年7月1日于解放军总医院第一医学中心住院的160例HP患者的临床资料,对确诊HP患者与首诊误诊为癫痫患者的临床资料进行比较分析。结果160例HP患者中,22例(男性12例,女性10例)在外院首诊误诊为癫痫,误诊率13.75%,误诊中位时间8.0(2.0~14.8)年。误诊癫痫的22例患者临床表现主要包括肢体搐搦(81.8%,18/22)、意识障碍(27.3%,6/22)、肢体麻木(13.6%,3/22)、肢体无力(27.3%,6/22)、精神行为异常(9.1%,2/22)和记忆力减退(13.6%,3/22)。9例行脑电图检查,以慢波、棘-慢复合波为主3例,θ和δ频段背景减慢2例,余4例正常。15例行头颅CT检查,其中13例存在颅内钙化。院外均应用抗癫痫药物,其中17例应用了两种药物。入院确诊后,经补充钙剂、骨化三醇治疗后,17例抗癫痫药物逐渐减量停用;5例合并继发性癫痫,抗癫痫药物种类减至1种且病情较前易于控制。结论HP患者临床表现复杂多变,其中癫痫样发作容易被误诊为原发性癫痫,应重视血钙、磷及甲状旁腺激素检测,避免延误诊治。

Background Patients with hypoparathyroidism always present with recurrent tetany caused by hypocalcemia.These patients are usually misdiagnosed as epilepsy and incorrectly treated with anti-epileptic drugs.Objective To analyze the clinical data about 22 patients with hypoparathyroidism misdiagnosed as epilepsy and summarize the clinical experience for reducing misdiagnosis and mistreatment about hypoparathyroidism.Methods Totally 160 patients with hypoparathyroidism who were administrated to the First Medical Center of Chinese PLA General Hospital from January 1,2008 to July 1,2021 were enrolled in this report.Clinical about 22 patients initially misdiagnosed with epilepsy were analyzed.Results Of the 160 cases with hypoparathyroidism,22 patients(12 males and 10 females)were misdiagnosed with epilepsy in local hospitals.The misdiagnosis rate was 13.75%and the median duration of misdiagnosis was 8.0(IQR:2.0,14.8)years.The clinical manifestations of the 22 patients misdiagnosed as epilepsy included tetany in 18 cases(81.8%),disturbance of consciousness in 6 cases(27.3%),limb numbness in 3 cases(13.6%),limb weakness in 6 cases(27.3%),mental and behavioral abnormality in 2 cases(9.1%),and memory impairment in 3 cases(13.6%),etc.Electroencephalogram(EEG)was performed in 9 cases,which presented as slow wave and spike-slow complex wave in 3 cases,slowing down ofθandδband background in 2 cases and normal EEG in 4 cases.Fifteen cases underwent head computed tomography(CT)scan,in which 13 cases had intracranial calcification.All patients were treated with anti-epileptic drugs,of which 17 patients were treated with two kinds of drugs.After diagnosis,anti-epileptic drugs were gradually reduced and withdrawn after calcium and calcitriol treatment in 17 cases.In the other 5 cases with secondary epilepsy,the anti-epileptic drugs was reduced to one type and their clinical condition improved obviously.Conclusion The clinical manifestations of hypoparathyroidism are complex and usually misdiagnosed as primary epilepsy.Detection of serum calcium,phosphorus and parathyroid hormone is very important to avoid misdiagnosis and mistreatment about hypoparathyroidism.