痉挛型偏瘫脑电图癫癎样放电危险因素分析

Risk factors for interictal epileptiform discharges on electroencephalogram in children with spastic hemiplegic cerebral palsy

摘要:

目的探讨痉挛型偏瘫的临床表现及脑电图发作间期癫癎样放电(IED)特征,并分析IED相关危险因素。方法收集83例痉挛型偏瘫患儿的临床资料、视频脑电图、影像学检查及认知功能评定结果等。采用多因素logistic回归分析IED的影响因素。结果 13%痉挛型偏瘫患儿伴有癫癎。34%患儿伴IED,IED组癫癎发生率(32%)较非IED组者(4%)显著升高(P<0.01)。存在合并症、皮层受累者IED发生率显著增高(P<0.01);不同认知水平组其IED发生率差异有统计学意义(P<0.01)。皮层受累、认知水平低下是痉挛型偏瘫伴IED的危险因素(OR分别为11.521、2.238, P<0.05)。结论痉挛型偏瘫常伴IED,存在IED者癫癎发生率更高。皮层受累及认知水平低下对痉挛型偏瘫伴IED有预测价值。

Abstract:

Objective To investigate the clinical symptoms and features of interictal epileptiform discharges (IED) on electroencephalogram (EEG) in children with spastic hemiplegic cerebral palsy (CP) and to analyze the risk factors for IED. Methods Eighty-three children with spastic hemiplegic CP were recruited, and their clinical data, results of video-electroencephalogram, imaging findings, and cognitive levels were collected. The influencing factors for IED were determined by multiple logistic regression analysis. Results The incidence of epilepsy was 13% in children with spastic hemiplegic CP; 34% of these cases had IED. The incidence of epilepsy in children with IED (32%) was significantly higher than that in those without IED (4%) (P<0.01). The incidence of IED in children with complications and brain cortex impairment increased significantly (P<0.01). The incidence of IED varied significantly between patients with different cognitive levels (P<0.01). Brain cortex impairment (OR=11.521) and low cognitive level (OR=2.238) were risk factors for IED in children with spastic hemiplegic CP (P<0.05). Conclusions Spastic hemiplegic CP is often found with IED on EEG, and the incidence of epilepsy is higher in children with IED than in those without IED. Brain cortex impairment and low cognitive level have predictive values for IED in children with spastic hemiplegic CP.