以痫性发作为首发症状的副肿瘤性边缘性脑炎诊疗探讨并文献复习

Discussion and Literature Review on the Management of Paraneoplastic Limbic Encephalitis with Epileptic Seizures as the First Symptom

目的:探讨以痫性发作为首发症状的副肿瘤性边缘性脑炎(paraneoplastic limbic encephalitis,PLE)的临床表现、诊断及治疗策略。方法:回顾分析1例以痫性发作为首发症状的PLE患者的临床特点、实验室检查结果,并做文献复习。结果:PLE临床非常罕见,可根据细胞内抗原抗体或抗神经元表面抗原抗体类型,分为PLEⅠ型与PLEⅡ型。对于PLE高度怀疑者,在确诊的同时,应及早运用手术、放疗或化疗等方式治疗肿瘤,以缓解其神经系统症状。结论:PLE临床表现复杂多样,容易误诊、漏诊,早期确诊和抗肿瘤治疗对患者的预后具有重要意义。

Objective:To investigate the clinical presentation,diagnosis and treatment strategy of paraneoplastic limbic encephalitis(PLE)with epileptic seizures as the first symptom.Methods:The clinical features and laboratory findings of a patient with PLE with epileptic seizures as the first symptom were retrospectively analyzed,and a literature review was done.Results:PLE is very rare clinically and can be classified into PLE typeⅠand PLE typeⅡbased on the type of intracellular antigen antibody or anti-neuronal surface antigen antibody.For those with high suspicion of PLE,surgery,radiotherapy or chemotherapy should be applied early to treat the tumor while confirming the diagnosis to relieve their neurological symptoms.Conclusion:The clinical manifestations of PLE are complex and diverse,and it is easy to misdiagnose and miss the diagnosis.Early diagnosis and anti-tumor treatment are of great significance to the prognosis of patients.