儿童良性癫痫伴中央颞区棘波出现睡眠中癫痫电持续状态危险因素分析

摘要

目的 探讨儿童良性癫痫伴中央颞区棘波(BECT)出现睡眠中癫痫电持续状态(ESES)的危险因素.方法 纳入2013年1月至2017年1月在福建医科大学附属省立临床医学院儿科神经科门诊诊断为BECT的80例息儿,根据病程中是否出现睡眠中癫痫电持续状态(ESES)现象,分为ESES组(38例)和无ESES组(42例).回顾性分析各病例的年龄、性别、首次癫痫发作年龄、治疗前发作次数、发作形式、治疗药物、治疗后发作、热性惊厥、出生情况、家族史、头颅磁共振成像(MRI)、脑电图放电数量、放电部位、智力等情况,采用多元Logistic回归分析探讨出现ESES现象的危险因素.结果 ESES组和无ESES组BECT患儿相比,治疗后仍有发作(68.4％比26.2％,P＜0.001),且智力发育更差(＜90分)(73.7％比38.1％,P=0.001);同时脑电图显示放电前移(47.4％比21.4％,P=0.014)及放电双侧分布(52.6％比26.2％,P=0.015).通过Logisitc回顾分析仅提示治疗后复发是BECT患者出现ESES现象的高危因素(P=0.008,OR=4.039,95％CI:1.429～11.418).结论 BECT治疗后仍有癫痫发作是ESES现象的高危因素.控制发作,减少ESES现象,有利于减轻ESES患儿智力损害.%Objective To evaluate the risk factors for benign childhood epilepsy with centrotemporal spikes (BECT) complicated by electrical status epilepticus in sleep(ESES).Methods From January 2013 to January 2017,a total of 80 children diagnosed as BECT in pediatric neurology outpatient department of Provincial Clinical Medical College Affiliated to Fujian Medical University were enrolled.According to whether there was an attack of ESES or not,patients were divided into ESES group(38 cases) and non-ESES group(42 cases).In order to elucidate risk factors for BECT complicated by ESES,clinical data including age,gender,first seizure age,seizure frequency before treatment,types of seizure,therapeutic drug,recurrence of seizure after treatment,febrile seizure,status at birth,family history,brain MRI,discharge quantity,discharge location,and intelligence score were investigated by multivariate Logistic regression analysis.Results Compared with non-ESES patients,ESES patients were more likely to have recurrence of epilepsy after treatment (68.4％ vs 26.2％,P ＜ 0.001),and had worse intellectual development (＜ 90 scores;73.7％ vs 38.1％,P =0.001);while electroencephalogram showed more discharge in anterior location (47.4％ vs 21.4％,P =0.014) and bilateral distribution of brain (52.6％ vs 26.2％,P =0.015).However,the multivariate Logistic regression analysis showed that only recurrence of seizure after treatment was the risk factor for ESES in BECT patients(P=0.008,OR=4.039,95％CI:1.429-11.418).Conclusion Recurrence of seizure after treatment of BECT was a high risk factor for ESES.Controlling seizure and reducing ESES phenomenon could be beneficial to alleviate the intellectual impairment of patients with BECT.