轻度胃肠炎并婴幼儿良性惊厥40例临床分析

Benign infantile convulsions with mild gastroenteritis: clinical analysis of 40 cases

摘要:

目的：研究轻度胃肠炎并婴幼儿良性惊厥的临床特征、病因及治疗措施。方法：收集本院住院的轻度胃肠炎并婴幼儿良性惊厥的患儿40例。观察记录患儿住院期间的胃肠炎表现及惊厥特点，并进行总结。用金标法及ELISA对患儿粪便及脑脊液进行轮状病毒及杯状病毒进行检测。随访半年以上。结果：患儿胃肠症状多较轻微，无或轻度脱水；惊厥多为成簇发作；血清电解质及血糖正常或基本正常；脑脊液及头颅影像学检查正常；发作间期脑电图：8例于中央中线或中央区或额区少量癫癎样放电， 1例中央中线及顶区癫癎样波发放明显，其他31例未见异常或睡眠背景欠佳；粪便轮状病毒抗原检测阳性11例，杯状病毒抗原阳性4例；脑脊液轮状病毒及杯状病毒抗体均为阴性；28例苯巴比妥钠预防性肌注（每次5～10 mg/kg）后惊厥再发22例；随访半年以上，1例进展为癫癎，39例无惊厥发作及其他神经系统后遗症。结论：轻度胃肠炎并婴幼儿良性惊厥消化系统表现轻，惊厥往往成簇发作；致惊机制尚不清楚，病毒引起脑炎的可能性不大；常规剂量的苯巴比妥钠肌注不能预防惊厥的反复发作；绝大多数患儿预后良好。［中国当代儿科杂志，2010，12（7）：533-535］

Abstract:

OBJECTIVE: To investigate the pathogenesis, clinical characteristics and treatment of benign infantile convulsions with mild gastroenteritis (BICG). METHODS: The clinical manifestations and laboratory findings were observed in 40 children with BICG. The antigen and antibodies of rotavirus and calicivirus in stool and cerebral spinal fluid (CSF) were tested by the golden standard method and ELISA. The neurological outcome was evaluated by a follow-up of six months or more. RESULTS: All of the 40 children had mild gastroenteritis with or without minor dehydration. Cluster convulsions were observed in these children. There were normal findings in blood biochemistry (Na+, K+, Ca2+, Cl-, HCO3-, glucose) and cerebral CT or MRI examinations. The interictal EEG showed sprinkle central or frontal epileptiform discharges in 8 children; clear central and parietal epileptiform discharges in 1 child; and no abnormal findings were observed in the other 31 children. Positive rotavirus antigen was detected in 11 children and positive calicivirus antigen in stool samples in 4 children. Positive antibodies of rotavirus and calicivirus in CSF were not seen. Seizures recurred in 22 of 28 children who received prophylactic injections of phenobarbital（5-10 mg/kg）.In a 6 months follow-up, one child developed epilepsy and the other 39 children had no seizures and neurological sequelae. CONCLUSIONS: The digestive system manifestations are mild in children with BICG. Convulsions are always clustered in these children. The mechanism underlying convulsions is not clear. Conventional dose of phenobarbital is not effective for prevention of seizures. Most of children with BICG have a good prognosis. ［Chin J Contemp Pediatr, 2010, 12 (7):533-535］