伴有非癫癎发作的322例脑性瘫痪临床分析

Clinical analysis of 322 cases of non-epileptic cerebral palsy

摘要:

目的：了解伴有非癫癎发作的脑性瘫痪（脑瘫）的临床特点，以提高与癫癎发作的鉴别能力。方法：1 198例9个月至6岁的脑瘫患儿纳入研究，对伴随发作性症状的患儿进行24 h视频脑电图监测，明确伴随的发作是否为癫癎发作，并观察伴随非癫癎发作患儿的发作症状、年龄、脑瘫型别及脑电图特征。结果：共578例（48.24%）患儿伴随发作性症状，其中伴随癫癎发作者231例（19.28%），非癫癎发作322例（26.88%）。322例伴随非癫癎发作的脑瘫患儿中，发作性症状包括非癫癎性强直发作、发作性摇头、耸肩或头后仰、发作性哭闹、惊恐发作、睡眠肌阵挛、刻板性运动等；158例（49.1%）显示脑电图有非特异性异常；111例（34.5%）在基层医院误诊为癫癎；1岁以内患儿非癫癎发作频率高于1岁~和3~6岁组患儿；痉挛型脑瘫患儿非癫癎发作频率最高（168例，52.2%），其次为不随意运动型（69例，21.4%）和混合型(65例，20.2%)。结论：脑瘫患儿伴随的发作性症状部分为非癫癎发作，注意与癫癎发作相鉴别。非癫癎发作发生频率与患儿年龄及脑瘫型别有一定关系。［中国当代儿科杂志，2010，12(12)：933-935］

Abstract:

OBJECTIVE: To study the clinical features of non-epileptic seizures associated with cerebral palsy (CP) in children. METHODS: A total of 1 198 children with CP (age: 9 months to 6 years) were enrolled. The children with paroxysmal events were monitored by 24 hrs video-EEG (VEEG) to make sure the seizures were epileptic or non-epileptic. The symptoms, age, CP types and EEG features were observed in children with non-epileptic CP. RESULTS: Five hundred and seventy-eight children (48.24%) presented paroxysmal events. The seizures were epileptic in 231 children (19.28%) and non-epileptic in 322 cases (26.88%). In the 322 cases of non-epileptic CP, the paroxysmal events were of various kinds, including non-epileptic seizure tonic, seizure shake head, shrug shoulder or head hypsokinesis, cry or scream, panic attacks, sleep myoclonic and stereotyped movement. One hundred and fifty-eight (49.1%) out of the 322 children demonstrated nonspecific EEG abnormalities. One hundred and eleven children (34.5%) were misdiagnosed as epilepsy in primary hospitals. The CP children less than one year old showed higher frequency of non-epileptic seizures than the age groups over 1 year and 3 to 6 years. The frequency of nonepileptic seizures was the highest in children with spastic CP (168 cases, 52.2%), followed by dyskinetic CP (69 cases, 21.4%) and mixed type CP (65 cases, 20.2%). CONCLUSIONS: The paroxysmal events in children with CP partially are non-epileptic seizures and it is important to differentiate non-epileptic from epileptic seizures. The frequencies of non-epileptic seizures may be associated with a child’s age and CP type.［Chin J Contemp Pediatr, 2010, 12 (12):933-935］