摘要
目的观察发作性睡病与癫痫共患的临床诊断及治疗过程，提高对此类共患病例的认识。方法分析2例发作性睡病与癫痫共患患儿床资料、视频脑电图监测（VEEG）及多次睡眠潜伏期试验（MSLT）结果，其中1例进行了脑脊液下丘脑分泌素1水平的检测。结果例1以癫痫性肌阵挛发作起病，半年后出现兴奋时猝倒和睡眠增多，多次MSLT阳性，脑脊液下丘脑分泌素1明显降低，诊断为伴猝倒的发作性睡病。丙戊酸治疗后癫痫发作控制但嗜睡症状加重，联合给予盐酸哌甲酯及盐酸氯米帕明治疗后睡眠增多和猝倒症状好转，癫痫无复发。例2以睡眠增多和猝倒起病，MSLT阳性，未接受正规治疗。2年后发作性意识障碍伴自动症，VEEG显示一侧颞区慢波和棘波发放，诊断为复杂部分性发作，奥卡西平治疗后发作控制，但发作性睡病症状依然存在。结论发作性睡病与癫痫共患需根据临床症状、诱因、VEEG和MSLT检查进行诊断和鉴别诊断。抗癫痫药物可能加重嗜睡。在抗癫痴治疗控制癫痫发作的同时小剂量应用中枢兴奋性药物可改善嗜睡和猝倒症状。
Objective To analyze the clinical diagnosis and treatment process of narcolepsy and epilepsy co-existence, and thereby to improve awareness of such cases. Method The clinical manifestations of 2 cases were observed, and video-electroencephalogram （VEEG） , multiple sleep latency tests （MSLT） were performed. Hypoeretin 1 level in eerebrospinal fluid was examined in one case. Result The onset of disease of case one was started with epilepsy with myoclonic seizure. After half a year, catalepsy induced by emotion especially laughing and excessive daytime sleepiness appeared. MSLT was positive and hypocretin 1 level decreased. Narcolepsy-eataplexy was definitely diagnosed in this case. Valproate was given and seizure was controlled completely, but the excessive daytime sleepiness was aggravated. Combination of valproate, methylphenidate and clomipramine treatment improved the symptoms of narcolepsy and the patient was still free of epileptic seizures. The onset symptoms of case 2 were catalepsy and excessive daytime sleepiness. MSLT was positive. The treatment was ineffective because of bad compliance. After 2 years, episodes of impairment of consciousness with automatism occurred. VEEG showed slow waves and spikes in right temporal area. Complex partial seizure was determined. Oxcarbazepine was used and then the patients became seizures free, but the symptoms of narcolepsy were still obvious. Conclusion Comorbidity of narcolepsy and epilepsy is a rare phenomenon. Clinical symptoms, predisposing factor, VEEG and MSLT can help diagnosis and differential diagnosis. The antiepileptic drugs might aggravate drowsiness. Based on therapy of epilepsy by using antiepileptic drugs, low dosage of central nervous system stimulants might improve the drowsiness and catalepsy symptoms of narcolepsy.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第9期676-678,共3页
Chinese Journal of Pediatrics
