吡仑帕奈联合左乙拉西坦治疗儿童自限性癫痫伴中央颞区棘波合并睡眠中癫痫电持续状态的疗效与脑电频谱分析

doi:10.3969/j.issn.1006-5725.2026.13.020

摘要/Abstract

摘要：

目的评估吡仑帕奈联合左乙拉西坦治疗儿童自限性癫痫伴中央颞区棘波（self-limited epilepsy with centrotemporal spikes，SeLECTS）合并睡眠中癫痫电持续状态（electrical status epilepticus during sleep， ESES）的效果。方法选取2023年6月至2025年6月南通大学附属常州儿童医院收治的86例SeLECTS合并ESES患儿为研究对象，按随机数字表法分为对照组和观察组各43例。对照组口服左乙拉西坦，观察组在对照组的基础上联合应用吡仑帕奈，两组均治疗6个月。分别记录两组患者治疗前后的癫痫发作频率及持续时间、放电指数，并比较治疗前后的神经元特异性烯醇化酶（NSE）、脑电活动指标（θ波、β波、δ波、α波），通过韦氏儿童智力量表对患儿的操作智商、言语智商、全量表智商进行评价，记录不良反应发生情况。结果治疗后，观察组发作频率、持续时间和放电指数均低于对照组（P 0.05）；治疗后，观察组θ波、δ波较对照组提高，β波、α波较对照组降低，且观察组治疗后的神经损伤指标低于对照组，智力量表评分更高（P 0.05）。两组不良反应发生情况相比，差异无统计学意义（χ² = 1.042，P = 0.307）。结论吡仑帕奈联合左乙拉西坦治疗儿童SeLECTS合并ESES可显著减少癫痫发作、改善脑电活动与神经损伤指标、提升智力水平，且安全性良好。

关键词: 自限性癫痫伴中央颞区棘波, 睡眠中癫痫电持续状态, 吡仑帕奈, 左乙拉西坦

Abstract:

Objective To evaluate the efficacy and electroencephalographic （EEG） spectral changes of perampanel combined with levetiracetam in children with Self-Limited Epilepsy with Centrotemporal Spikes （SeLECTS） complicated by Electrical Status Epilepticus during Sleep （ESES）. Methods A total of 86 children with SeLECTS complicated by ESES， admitted to our hospital between June 2023 and June 2025， were enrolled. Participants were randomly assigned to a control group （n = 43） or an observation group （n = 43） using a random number table. The control group received oral levetiracetam monotherapy， while the observation group received perampanel added to the levetiracetam regimen. Both groups underwent a 6-month treatment course. Seizure frequency， seizure duration， and EEG spike-wave discharge index were recorded before and after treatment. Serum neuron-specific enolase （NSE） levels and EEG spectral parameters （relative power of delta， theta， alpha， and beta bands） were compared. Cognitive function was assessed using the Wechsler Intelligence Scale for Children （WISC）， evaluating performance IQ， verbal IQ， and full-scale IQ. Adverse events were systematically documented. Results Following treatment， the observation group demonstrated significantly lower seizure frequency， shorter seizure duration， and a reduced spike-wave discharge index compared with the control group （all P 0.05）. EEG spectral analysis revealed higher relative power of theta and delta waves， alongside lower beta and alpha wave power， in the observation group than in the control group （P 0.05）. The observation group also exhibited significantly lower NSE levels and higher WISC scores than the control group （P 0.05）. No significant difference was observed in the incidence of adverse events between the two groups （χ2 = 1.042， P = 0.307）. Conclusion The combination of perampanel and levetiracetam effectively reduces seizure burden， ameliorates EEG abnormalities， mitigates neuronal injury， and improves cognitive function in children with SeLECTS complicated by ESES， while maintaining a favorable safety profile comparable to levetiracetam monotherapy.

Key words: self-limited epilepsy with centrotemporal spikes, electrical status epilepticus during sleep, perampanel, levetiracetam

中图分类号:

R971.6

姜晓萍,吴婷,张雯婷,廖丽娜,刘建荣. 吡仑帕奈联合左乙拉西坦治疗儿童自限性癫痫伴中央颞区棘波合并睡眠中癫痫电持续状态的疗效与脑电频谱分析[J]. 实用医学杂志, 2026, 42(13): 2438-2443.

Xiaoping JIANG,Ting WU,Wenting ZHANG,Lina LIAO,Jianrong LIU. Efficacy and EEG spectral analysis of perampanel combined with levetiracetam in children with SeLECTS complicated by electrical status epilepticus during sleep[J]. The Journal of Practical Medicine, 2026, 42(13): 2438-2443.

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组别	例数	性别/例		年龄/岁	体质量/kg	病程/年	并发症/［例（%）］
组别	例数	男	女	年龄/岁	体质量/kg	病程/年	学习困难	行为障碍
对照组	43	27	16	7.46 ± 1.56	31.59 ± 4.48	3.16 ± 0.76	9（20.9）	7（16.3）
观察组	43	23	20	7.30 ± 1.34	31.22 ± 4.24	3.27 ± 0.79	6（14.0）	8（18.6）
t/χ²值		0.764		0.598	0.372	0.843	0.727	0.081
P值		0.382		0.552	0.711	0.402	0.394	0.776

组别	例数	发作频率/（次/月）		持续时间/（min/次）		放电指数/%
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	43	3.63 ± 0.75	2.14 ± 0.37	4.66 ± 0.70	2.22 ± 0.34	88.84 ± 8.58	69.85 ± 7.26
观察组	43	3.57 ± 0.72	1.00 ± 0.23	4.54 ± 0.62	1.46 ± 0.24	89.13 ± 9.03	60.47 ± 6.22
t值		0.381	17.159	0.842	11.975	0.153	6.434
P值		0.704	0.05	0.402	0.05	0.879	0.05

组别	例数	NSE
组别	例数	治疗前	治疗后
对照组	43	22.45 ± 4.54	16.31 ± 2.91
观察组	43	22.18 ± 4.42	12.02 ± 2.24
t值		0.279	7.660
P值		0.781	0.05

组别	例数	θ波		β波		δ波		α波
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	43	5.04 ± 0.65	6.09 ± 0.69	23.56 ± 3.12	18.11 ± 2.55	2.21 ± 0.34	2.62 ± 0.38	10.82 ± 1.76	10.07 ± 1.06
观察组	43	5.02 ± 0.61	6.91 ± 0.71	23.84 ± 3.27	15.89 ± 2.19	2.26 ± 0.39	3.08 ± 0.41	10.59 ± 1.51	9.10 ± 0.85
t值		0.147	5.431	0.406	4.331	0.634	5.396	0.650	4.630
P值		0.883	0.05	0.686	0.05	0.528	0.05	0.517	0.05

组别	例数	操作智商		语言智商		全量表智商
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	43	91.81 ± 5.32	99.97 ± 7.41	90.23 ± 5.41	99.01 ± 6.74	91.51 ± 5.62	101.13 ± 6.95
观察组	43	92.25 ± 5.49	105.24 ± 8.54	90.75 ± 5.68	109.25 ± 7.24	91.26 ± 5.41	107.60 ± 7.26
t值		0.283	3.056	0.589	6.788	0.193	4.689
P值		0.778	0.050	0.543	0.050	0.847	0.050