摘要
目的探索伴中央颞区棘波的自限性癫痫(SeLECTS)患儿临床发作后2种抗癫痫发作药物(ASMs)未控制的危险因素。方法回顾性分析2018年1月至2021年5月于郑州大学第三附属医院小儿神经内科确诊的112例SeLECTS患儿,纳入病例分析的患儿均予常规ASMs规范化治疗,定期随访1~2年,随访内容包括治疗药物种类、临床发作控制情况、是否出现新的发作形式、脑电图演变等。根据使用不超过2种ASMs后癫痫是否控制,将其分为反应良好组(69例)和反应不良组(43例),进一步分析其临床资料和脑电图特点,采用多因素Logistic回归分析探索2种ASMs未控制的危险因素。结果2组的起病年龄(χ^(2)=8.919,P=0.003)、发作形式(χ^(2)=4.218,P=0.040)、发作频次(Z=-7.664,P<0.001)、脑电图背景变慢(χ^(2)=10.284,P=0.001)、出现睡眠期癫痫性电持续状态(ESES)现象(χ^(2)=11.921,P=0.001)、放电泛化(χ^(2)=25.377,P<0.001)、演变为癫痫性脑病伴睡眠期棘慢波激活(EE-SWAS)(χ^(2)=54.334,P<0.001)差异均有统计学意义,多因素Logistic回归分析发现发作频次(P<0.001,OR=0.086,95%CI:0.022~0.329)、脑电图放电泛化(P=0.006,OR=9.942,95%CI:1.918~51.527)及脑电背景变慢(P=0.041,OR=6.648,95%CI:1.077~41.038)是与短期药物治疗反应不良相关的3个主要危险因素。结论大部分SeLECTS患儿临床发作易控制,预后良好,发作频次、脑电图放电泛化及脑电背景变慢与短期药物治疗反应不良相关。
Objective To explore risk factors for clinical onset in children with uncontrolled self-limited epilepsy with centrotemporal spikes(SeLECTS)managed by 2 anti-seizure medications(ASMs).Methods A total of 112 children with SeLECTS who were diagnosed at the Department of Pediatric Neurology of the Third Affiliated Hospital of Zhengzhou University from January 2018 to May 2021 were retrospectively reviewed.All of them were treated with conventional ASMs,and regularly followed up for 1-2 years.Types of therapeutic drugs,clinical seizure control status,presence of new seizure forms,electroencephalogram(EEG)were reviewed at follow-up visits.According to whether the seizures were controlled after the use of no more than 2 ASMs,patients were divided into poor response group(43 cases)and good response group(69 cases),and their clinical data and EEG characteristics were compared.Multivariate Logistic regression analysis was used to explore the risk factors for seizures that were uncontrolled by 2 ASMs.Results There were significant differences in the age of onset(χ^(2)=8.919,P=0.003),seizure form(χ^(2)=4.218,P=0.040),seizure frequency(Z=-7.664,P<0.001),EEG background slowing(χ^(2)=10.284,P=0.001),emergence of electrical status epilepticus during slow-wave sleep(ESES)(χ^(2)=11.921,P=0.001),discharge generalization(χ^(2)=25.377,P<0.001),and presence of epileptic encephalopathy with spike-and-wave activation in sleep(EE-SWAS)(χ^(2)=54.334,P<0.001)between groups.Multivariate Logistic regression analysis showed that seizure frequency(P<0.001,OR=0.086,95%CI:0.022-0.329),discharge generalization(P=0.006,OR=9.942,95%CI:1.918-51.527)and EEG background slowing(P=0.041,OR=6.648,95%CI:1.077-41.038)were the 3 main risk factors associated with poor response to short-term medications of ASMs.Conclusions Seizures are easily controlled in most SeLECTS patients medicated with ASMs with a favorable prognosis.Seizure frequency,discharge generalization and EEG background slowing are risk factors for the poor response to short-term pharmac
作者
梁瑞瑞
徐丹
关静
张晓莉
曹天思
陈姚瑶
贾天明
Liang Ruirui;Xu Dan;Guan Jing;Zhang Xiaoli;Cao Tiansi;Chen Yaoyao;Jia Tianming(Department of Pediatric Neurology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2023年第5期365-369,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
河南省医学科技攻关计划项目(LHGJ20200437)。
