新生儿惊厥视频脑电图特点及对预后判断价值

摘要

目的 回顾性分析新生儿惊厥视频脑电图(VEEG)特点及对新生儿惊厥预后判断的价值.方法 收集2010至2015年在北京大学第一医院因新生儿惊厥住院并且行VEEG检查的新生儿为研究对象,比较新生儿期和婴幼儿期VEEG异常特征和程度、新生儿期VEEG异常程度与婴幼儿期有否惊厥和神经发育异常的关系.结果 ①收录符合条件新生儿共61例,新生儿期VEEG轻度异常29例(47.5%),以阵发性异常和复合异常为主;中度异常24例(39.3%),以阵发性异常为主;重度异常7例(11.5%),以背景活动异常为主;暴发-抑制1例(1.6%).新生儿期VEEG严重程度与以后惊厥发作无相关性(rs=0.177,P=0.168),与神经发育不良显著相关(rs=0.486,P<0.001),婴幼儿期仍有惊厥发作与神经不良预后显著相关(rs=0.799,P<0.001);②出院后随访到39例,2例死亡,癫痫19例,其中治疗后仍有惊厥发作14例,有神经发育不良16例.新生儿期VEEG与婴幼儿期VEEG严重程度显著相关(rs=0.913,P<0.001);③新生儿期VEEG背景活动异常明显者以后神经发育不良发生率最高(87.5%).随访VEEG有背景活动异常和复合异常者100%有神经发育不良;阵发性异常和成熟性异常者神经发育不良率分别为50.0%和33.3%.结论 新生儿惊厥VEEG异常程度及背景活动对判断神经发育预后有重要参考意义.%Objective To analyze the characteristics and prognosis value of video electroencephalogram (VEEG) in neonatal seizures.Methods Newborns hospitalized for neonatal seizures and implemented with VEEG examinations in Peking University First Hospital from 2010 to 2015 were collected as study subjects.Characteristics and abnormalities of VEEG in neonatal period and in infancy were compared and relationship between neonatal VEEG abnormality and incidence of convulsion and neural developmental anomalies in infancy was analyzed.Results A total of 61 eligible neonates were included, among which 29 cases (47.5%) had mildly abnormal VEEG in neonatal period mainly manifesting with paroxysmal and composite anomalies, 24 cases (39.3%) had moderately abnormal VEEG mainly manifesting with paroxysmal anomalies, 7 cases (11.5%) had severe abnormality mainly manifesting with background activity anomalies, and 1 case (1.6%) had burst suppression pattern.There was no correlation between severity of VEEG abnormality in neonatal period and later seizure incidence (rs=0.177,P=0.168), but neonatal VEEG abnormality had significant correlation with neural dysplasia (rs=0.486,P<0.001).Seizure in infancy was significantly correlated with adverse prognosis of nerve development (rs=0.799, P<0.001).Thirty-nine cases were followed up after discharge, among which 2 cases died, 19 cases had epilepsy with 14 cases having convulsion after treatment, and 16 cases had neural dysplasia.Severity of VEEG abnormality in neonatal period and in infancy was significantly correlated (rs=0.913,P<0.001).Incidence of neural dysplasia was high (87.5%) among cases with VEEG background activity abnormality in neonatal period.All patients (100%) with VEEG background abnormality and composite anomalies during follow-up had neural dysplasia.Incidence of neural dysplasia in cases with paroxysmal abnormality and mature abnormality was 50.0% and 33.3%, respectively.Conclusion Abnormal degree of VEEG and the background activity have important reference value in judging prognosis of neural development in neonatal seizures.