癫痫性痉挛患儿49例

Analysis of electroclinical features of 49 children with epileptic spasm

目的分析49例癫痫性痉挛患儿的临床、脑电图(EEG)特征。方法对2014年6月至2022年8月于哈尔滨医科大学附属第一医院进行视频脑电监测(VEEG)证实有癫痫性痉挛发作且有完整临床资料的49例患儿临床和EEG资料进行分析,并按痉挛起病年龄分为三组:早发型痉挛(EOS)组,婴儿痉挛(IOS)组,晚发型痉挛(LOS)组。结果①出生异常史EOS组与IOS组相比,差异有统计学意义(P<0.05);②精神运动发育迟滞LOS组与IOS组相比,差异有统计学意义(P<0.05);③神经影像学检查异常三组分别为75%、75%、100%;④发作间期IOS组高度失律常见,且睡眠期增多;EOS组、IOS组癫痫样放电均为后头部优势;⑤监测时发作特点为成串或孤立性痉挛可混合不典型失神发作、肌阵挛发作、强直发作等多种发作形式。结论婴儿期癫痫性痉挛具有特征性临床和EEG表型,临床医生应重视其不典型症状及EEG变异型。

Objective To compare the clinical and electroencephalogram(EEG)characteristics in patients with epileptic spasm in different age groups.Methods From June 2014 to August 2022,the clinical and EEG data of 49 patients with epileptic spasms and complete clinical data confirmed by video-EEG monitoring in The First Affiliated Hospital of Harbin Medical University were retrospectively analyzed.According to the age of onset of spasm were divided into three groups:early onset spasm(EOS),infantile spasm(IOS)and late onset spasm(LOS).Results①The three groups with abnormal birth history was 87.5%,37.5%and 55.6%,respectively,and difference in EOS and IOS groups was statistically significant(P<0.05);②The abnormal psychomotor development was 100%in EOS and IOS group,and 55.6%in LOS group,and difference in LOS and IOS groups was statistically significant(P<0.05);③The abnormal neuroimaging was 75%,75%and 100%,respectively;④The interictal EEG was mostly focal,multifocal or generalized epileptiform discharges and hypsarrhythmia,among which hypsarrhythmia was most common in the IOS group,and the number increased during sleep;the epileptiform discharge was more obvious in the occiput of EOS and IOS groups;⑤the characteristics of the seizures during monitoring was cluster or isolated spasms,which could be accompanied by atypical absence seizures,myoclonic seizures,tonic seizures and other forms of seizures.Conclusion Epileptic spasm in infancy has characteristic clinical and EEG phenotypes.Clinicians should pay attention to the atypical symptoms and EEG variations.