儿童单纯疱疹病毒性脑炎后癫痫14例临床特点分析

Clinical characteristics of epilepsy after herpes simplex virus encephalitis in children:an analysis of 14 cases

目的总结儿童单纯疱疹病毒(HSV)性脑炎(HSE)后癫痫的临床特点。方法回顾性收集2017年3月至2022年6月华中科技大学同济医学院附属武汉儿童医院神经内科确诊的单纯疱疹病毒性脑炎患儿14例资料,对其临床表现、脑脊液检查、脑电图及影像学等进行分析和总结。随访10个月至5年,评估是否患有脑炎后癫痫(PEE),并分为脑炎后癫痫组和非癫痫组,并比较脑炎急性期临床资料、脑脊液、脑电图及影像学等参数。结果14例中7例诊断为PEE,其中男5例、女2例,起病年龄4~110月龄(中位数11月龄)。所有患儿均使用两种及两种以上抗癫痫药物治疗,其中3例为难治性癫痫。所有患儿均遗留后遗症如认知障碍、运动障碍等。比较HSE后.出现PEE与非PEE组间脑脊液各指标差异均无统计学意义(P>0.05)。结论单纯疱疹病毒性脑炎后继发癫痫的可能性很大,部分发展为难治性癫痫,急性期惊厥发作或癫痫持续状态可能是PEE的高危因素。

Objective To summarize the clinical features of epilepsy after herpes simplex virus encephalitis(HSE)in children.Methods The data of 14 children with herpes simplex encephalitis diagnosed in the Department of Neurology,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology from March 2017 to June 2022 were retrospectively collected,and their clinical manifestations,cerebrospinal fluid examination,EEG and imaging were analyzed and summarized.After that,the patients were followed up for 10 months to 5 years to evaluate whether they had postencephalitic epilepsy(PEE),then they were divided into post encephalitis epilepsy group and non epilepsy group,to compare the clinical data include cerebrospinal fuid,VEEG and imaging parameters in the acute phase of encephalitis.ResultsSeven of the 14 children were diagnosed with postencephalitic epilepsy including 5 males and 2 females with an onset age of 4-110 months(media 11 months)months.All the children were treated with two or more antiepileptic drugs,and 3 of them had refractory epilepsy.All patients had residual sequelae such as cognitive and motor disorders,and there was no statistically significant difference between the PEE and non PEE groups after HSE.Conclusion There is a high possibility of secondary epilepsy after herps simplex virus encephalitis,with some developing into refractory epilepsy.Acute phase seizures or status epilepticus may be high-risk factors for postencephalitic epilepsy.