口服抗癫癎药物治疗儿童热性惊厥的临床与脑电图分析

Clinical and EEG features in children with febrile seizures after antiepileptic drug therapy

摘要:

目的：了解有癫癎高危因素的热性惊厥患儿应用丙戊酸钠与托吡酯口服治疗4年的临床与脑电图改变情况。方法：对2004~2005年的132例有应用抗癫癎药物指征的热性惊厥患儿给予丙戊酸钠与托吡酯口服治疗，每半年随访一次病情变化、血常规和肝肾功能；每一年随访一次睡眠脑电图，共随访4年。结果：随访时间1~10年，丙戊酸钠口服液单药治疗110例，长期控制率为98.2%，95例已停药，10例正处在减药过程中。托吡酯单药治疗13例，均发作控制，顺利停药。无一例出现血常规和肝肾功能异常表现。治疗后睡眠脑电图恢复正常者102例，出现局灶性改变者8 例，两侧同步性棘慢波4例，3 Hz棘慢波及多棘慢波2例。结论：对于癫癎高危因素的热性惊厥患儿，早期使用抗癫癎药物丙戊酸钠或托吡酯，疗效确切，无明显不良反应。抗癫癎药物治疗后大部分患儿睡眠脑电图恢复正常。

Abstract:

OBJECTIVE: To investigate the changes of clinical and EEG features in children with febrile seizures which are prone to epilepsy four years after antiepileptic drugs valproate and/or topiramate treatment. METHODS: One hundred and thirty-two children with febrile seizures between 2004 and 2005 and who had the indications of antiepileptic drugs treatment were administered with oral valproate and/or topiramate treatment. The children were followed up for four years. Routine blood tests, liver and renal function tests were performed twice a year. Sleeping activation EEG examination was performed once a year. RESULTS: During the follow-up of 1 to 10 years, 108 (98.2%) out of 110 children with valproate monotherapy were seizure-free. In the 110 cases, 95 were in the drug withdrawl and 10 were in the drug reduction. All of 13 cases receiving topiramate monotherapy were seizure-free and were in the drug withdrawl. None of the patients showed abnormalities in routine blood tests, liver and renal functions tests. Sleeping activation EEG showed normal in 102 cases, focal discharges in 8 cases, bilateral synchronized spikes in 4 cases and 3Hz spikes and polyspikes in 2 cases. CONCLUSIONS: Early use of antiepileptic drugs valproate or topiramate is effective and safe in children with febrile seizures which are prone to epilepsy. The majority of the children have a normal sleeping activation EEG after antiepileptic drug therapy.