学龄前脑性瘫痪儿童共患癫痫的临床特征和危险因素分析

Clinical features and risk factors for comorbid epilepsy among preschool children with cerebral palsy

目的对学龄前脑性瘫痪患儿共患癫痫的病因、脑瘫分型、粗大运动功能分级系统(GMFCS)和颅脑磁共振分类系统(MRICS)进行特征和危险因素分析。方法选取2016年1月至2022年12月在青岛大学附属妇女儿童医院康复科和青岛市脑病康复医院住院治疗, 年龄6个月至6岁, 符合入选标准的脑瘫患儿837例。根据是否存在癫痫分为癫痫组174例和非癫痫组663例, 收集2组患儿的临床资料, 对2组患儿的一般资料、脑瘫类型、脑瘫病因、GMFCS、MRICS和盖泽尔(Gesell)发育量表评分进行统计学分析。结果 174例癫痫患儿中, <3岁的癫痫确诊者有158例(90.8%)。癫痫组和非癫痫组最常见的脑瘫类型分别为痉挛型四肢瘫(50.0%)和痉挛型双瘫(42.1%), 2组在脑瘫分型方面的组间差异有统计学意义(P<0.05)。病因方面, 癫痫组脑发育异常及遗传因素、窒息缺氧史的例数与非癫痫组比较, 差异均有统计学意义(P<0.01)。癫痫组的GMFCS分级与非癫痫组比较, 差异有统计学意义(P<0.05)。2组MRICS的分布组间差异有统计学意义(P<0.05), 癫痫组灰质损伤为主者达31.6%, 癫痫组与非癫痫组均以白质损伤占比最高, 分别为40.8%和53.7%。认知功能方面, 癫痫组与非癫痫组Gesell发育商均值分别为52.21和70.59, 组间差异有统计学意义(P<0.05)。结论不同年龄、病因、脑瘫类型、GMFCS和MRICS的脑瘫患儿共患癫痫的临床特征不同。年龄<3岁、存在脑发育异常及遗传因素或窒息缺氧病因、脑瘫类型为痉挛型四肢瘫、MRICS以灰质损伤为主型、GMFCS分级越高, 脑瘫共患癫痫的比例也越大, 且共患癫痫的脑瘫患儿, 其认知落后更严重。

ObjectiveTo analyze the etiology and typology of cerebral palsy(CP)in preschool children with comorbid epilepsy,and their gross motor function(GMFCS)and cranial magnetic resonance(MRICS)classifications.MethodsA total of 837 children(aged 6 months to 6 years)hospitalized with cerebral palsy were divided into an epileptic group(n=174)and a non-epileptic group(n=663).Their general data,CP type,CP etiology,GMFCS classifications,MRICS classifications and Gesell development scores were analyzed.ResultsAmong the 174 children with epilepsy,158(90.8%)were under 3 years old.The most common type of CP in the epilepsy group was spastic quadriplegia(50.0%).In the non-epilepsy group it was spastic diplegia(42.1%),a significant difference.There were also significant differences between the two groups in terms of etiology.The number of cases of abnormal brain development differed significantly,as did genetic factors and history of asphyxia.There were also significant differences between the two groups in terms of GMFCS classifications and the distribution of MRICS classes.In the epileptic group,the proportion of gray matter injury was 31.6%.However,white matter injury ranked first in both the epileptic group and the non-epileptic group,reaching 40.8%and 53.7%,respectively.In terms of cognitive functioning there were significant differences in the groups′mean Gesell developmental quotients:epileptic group 52.21 and non-epileptic group 70.59.ConclusionsThe clinical characteristics of CP children with comorbid epilepsy differ with age,CP cause and type,as well as GMFCS and MRICS classifications.Children less than 3 years old with brain mal-developments and genetic factors or asphyxia-hypoxia etiology mostly display spastic quadriplegia CP.They mainly suffer from gray matter injury.The higher the GMFCS classification,the greater the proportion of CP with co-occurring epilepsy and the more severe the cognitive lag tends to be.