视频脑电图监测结合药物试验治疗对小儿非惊厥性癫(癎)持续状态的诊断意义

摘要

Objective To explore the values of video electroencephalogram (VEEG) in clinical diagnosis and observation of curative effect of nonconvulsive status epilepticus( NCSE) in children. Methods Twenty - seven cases of suspected NCSE who hospitalized in Neurology and Rehabilitation Center in Beijing Children's Hospital Affiliated to Capital Medical University from Sep. 2007 to Mar. 2011 were analyzed retrospectively. All cases were monitored with VEEG at least one time, in which 23 patients received diazepam intravenous injection during the VEEG monitoring. Results There were 15 boys and 12 girls in this group,and the ages of patients were from 1 year and 8 months old to 9 years old, the average age was 4 years and 8 months. Six cases were diagnosed as NCSE eventually, in which 2 cases of which were absence status,4 cases were complex partial epileptic status. For the other cases, 19 cases were diagnosed as viral encephalitis, 1 case was diagnosed as partial seizure, secondary generalized seizure and epileptic encephalopathy, another 1 case was status after seizure. Six cases diagnosed as NCSE received intravenous diazepam injection during the VEEG monitoring, in which the VEEG became normal in 3 cases, and significantly improved in the other 3 cases, at the same time, the state of consciousness were improved in 5 cases, and the other one was improved later. The continuous VEEG monitoring confirmed the diagnosis, but the clinical status and EEG were not improved after diazepam intravenous injection in the other 17 patients. Conclusion Continuous VEEG monitoring combined with intravenous diazepam injection was an efficient and valuable method in the diagnosis of NCSE in Children.%目的 探讨视频脑电图(VEEG)对小儿非惊厥性癫(癎)持续状态(NCSE)临床诊断、疗效观察的意义.方法 回顾性分析2007年9月-2011年3月于首都医科大学附属北京儿童医院神经内科拟诊为NCSE患儿27例,本组患儿均进行至少1次VEEG监测,其中23例患儿在VEEG监测同时进行地西泮静脉注射观察.结果 27例患儿中男15例,女12例；就诊年龄1岁8个月～9岁,平均4岁8个月；确诊为NCSE 6例,其中2例为失神持续状态,4例为复杂局限性癫(癎)持续状态；其余患儿分别诊断为病毒性脑炎19例,癫(癎)(局限性发作继发全面性发作、负性肌阵挛)并癫(癎)性脑病1例,癫(癎)(复杂局限性发作及局限性发作继发全面性发作)发作后状态1例.6例NCSE患儿在给予地西泮静脉注射诊断性治疗后3例脑电图转为正常,3例脑电图明显改善,同时意识状态改善者5例.1例患儿意识状态延迟,经连续VEEG监测后证实了NCSE的诊断,其余17例患儿在给予地西泮静脉注射后临床状态或者脑电图表现均无明显改善.结论 VEEG结合地西泮静脉注射可协助NCSE的诊断和鉴别诊断及临床疗效观察.