摘要
目的分析儿童非惊厥性癫痫持续状态（NCSE）的临床与脑电监护（VEEG）资料，指导临床诊断与治疗。方法1．研究对象：2009年10月至2012年9月复旦大学附属儿科医院神经科住院的17例NCSE病例，诊断符合Kaplan等的诊断标准；2．资料分析：17例NCSE患儿的临床特征、原发病因、脑电图监测等；3．治疗方法：氯硝西泮0．05mg／（kg·次），每天2次静脉注射，疗效欠佳者合用其他止痉药物；4．疗效评估：临床评估（记录认知改善与恢复正常的时间）与VEEG监测（记录背景活动或发作性异常明显改善与恢复正常的时间）。结果17例NCSE患儿男9例，女8例；起病年龄11个月-11．4岁；临床发作持续时间为4h-3个月；NCSE临床表现多样，表现为不同程度的意识障碍、精神异常、认知行为问题，部分可继发于惊厥或惊厥持续状态；17例患儿中单纯NCSE发作有12例，另外5例伴继发于全身强直阵挛性发作（GTCS＋NCSE）、其中2例并有惊厥性癫痫持续状态；17例患儿中11例（65％）存在相关病因；VEEG监测发作期主要以背景电活动变慢伴局灶性或全面性慢波的持续或周期性发放为特征；氯硝西泮单药治疗3d后11例患儿发作完全控制；余6例患儿再联合其他药物治疗，2例控制，4例好转；6例原因不明者均在氯硝西泮静脉滴注后72h内NCSE被完全控制，而中枢感染后遗症、代谢性疾病及大脑结构性损伤患儿恢复时问均在3d以上。结论不同程度的意识障碍伴精神及行为异常为NCSE的临床特征，病因多样，儿童NCSE易于误诊；急救治疗前后VEEG监护是确定NCSE病例诊断与判断疗效的重要手段；氯硝西泮静脉注射可有效控制儿童NCSE发作，且NCSE治疗起效时间与原发病因有关。
Objective To explore the clinical features and video-electroencephalogram （VEEG） monitoring of nonconvulsive status epilepticus （NCSE） in children. Methods 1. Object of study： Seventeen patients of NCSE diag- nosed with Kaplan＇s criteria were analyzed in Children＇s Hospital of Fudan University between Oct. 2009 and Sep. 2012.2. Data analysis： Data on demographics, etiology, clinical manifestation and response to clonazepam therapy were analyzed. 3. Therapies ： Clonazepam 0.05 mg/kg was intravenously injected twice a day. Treatment of poor efficacy pa- tients was combined with other antiepileptic drugs. 4. Therapeutic effect ： Clinical assessment of cognitive improvement and VEEG monitoring of background activity or paroxysmal abnormalities were analyzed. Results Nine male and 8 female of 17 patients with NCSE were involved, from 11 months to 11.4-year old. The chnical attacks lasted ranging vari- ously time from 4 hours to 3 months. Each patient had a prolonged change of consciousness,accompanied by psychologi- cal or behavioral changes. Definite medical causes were identified in 65% （ 11/17 cases） of the patients. Secondary ep- ilepsy was the dominating cause. The characteristics of ictal VEEG in NCSE generally included slow activity and focal or generalized 8 or 0 activity. After clonazepam treatment,the conditions of 13 patients were under complete control, in which 4 had improvement. Six cases of unknown cause were fully controlled within 72 hours after intravenous injection of clonazepam. The prognosis of CNS infection sequelae patients, metabolism disorders and brain structural damage was poor. Conclusions NCSE may present with confusion, behavioral disturbances and psychiatric conditions. The diagno- sis can be made by the ictal and interictal VEEG monitoring. It is necessary to make the diagnosis and control the sei- zures as quickly as possible. Clonazepam is useful in NCSE.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第9期708-711,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
非惊厥性癫痫持续状态
视频脑电图
氯硝西泮
儿童
Nonconvulsive status epilepticus
Video-electroencephalogram
Clonazepam
Child
