儿童睡眠中癫痫性电持续状态脑电图特点与疗效的相关性

doi:10.3969/j.issn.1006-5725.2024.04.015

摘要/Abstract

摘要：

目的探讨睡眠中癫痫性电持续状态（ESES）患儿的脑电图特点与疗效的相关性。方法纳入广州市妇女儿童医疗中心2014-2020年符合条件的ESES病例。分析出现ESES的年龄、ESES持续时间、清醒期棘波指数（SWI）、棘波分布、临床综合征、药物治疗后转归。根据棘波分布将ESES分为4组：局灶性ESES、一侧性ESES、双侧不对称性ESES、多灶性ESES；根据ESES期间清醒期SWI分为3组：≤ 20%、21% ~ 49%、≥ 50%；根据治疗后转归分为3组：预后良好组、控制组、无效组。结果总计纳入50例病例，男32例，女18例。 ESES的平均起始年龄为6岁7个月，平均持续时间为28个月。ESES的棘波分布与疗效相关：双侧不对称性ESES较多灶性ESES疗效好；ESES的持续时间与疗效有显著相关性，持续时间超过1年疗效更差；ESES期间清醒期SWI与疗效相关，清醒期放电指数≤ 20%疗效较好；ESES的起病年龄与ESES持续时间、清醒期SWI指数呈负相关，ESES持续时间与清醒期SWI指数呈正相关。结论 ESES起始时间、棘波分布、持续时间、清醒时SWI均与疗效相关，清醒期放电指数≤ 20%疗效较好，ESES持续1年以上的患者往往出现不良结果。ESES起病年龄越早，ESES持续时间会越长，清醒期棘波指数会越高。

关键词: 睡眠中癫痫性电持续状态, ESES起始年龄, ESES 棘波分布, ESES持续时间, 清醒期棘慢波指数, 疗效

Abstract:

Objective To explore EEG characteristics and the therapeutic effect in children with electrical status epilepticus during slow sleep （ESES）. Methods The eligible ESES cases in our center from 2014 to 2020 were included. The age at diagnosis of ESES， the duration of ESES， spike wave index （SWI） during wakefulness and the distribution of spike wave during the period of ESES， age at seizure onset， the clinical syndromes and the outcomes after treatment were analyzed. The ESES cases were divided into 4 groups according to the distribution of spike wave： focal ESES， unilateral ESES， bilateral asymmetric ESES， multiple foci ESES. The SWI during the awake stage were divided into 3 groups based on the different rates： ≤ 20%， 21% ~ 49%， ≥ 50%. The therapeutic outcomes were classified into three groups： satisfactory response，seizure control and ineffective. Results 50 cases were included， with 32 males and 18 females. The average onset age of ESES was 6 years and 7 months， and the average duration of ESES was 28 months. A significant correlation between the distribution of ESES and the therapeutic effects was found， bilateral asymmetric ESES had a good therapeutic effects， while multiple foci ESES showed a poor therapeutic effects. The duration of ESES was significantly correlated with therapeutic effects，and the efficacy was worse when the duration was longer than 1 year. A significant relationship between the SWI during wakefulness of ESES and the therapeutic effects was detected，the patient with SWI ≤ 20% during wakefulness had a good therapeutic effect.There was a negative correlation between the onset age of ESES and the duration of ESES and SWI index during wakefulness. There was a positive correlation between the duration of ESES and SWI index during wakefulness. Conclusion Our results suggest that onset age，distribution， duration and SWI during wakefulness of ESES were correlated with therapeutic outcomes， The patient with SWI ≤ 20% during wakefulness had a good therapeutic effect and have unfavorable outcomes with ESES last more than 1 year.The earlier onset of ESES， the longer duration of ESES and higher SWI during wakefulness will be showed..

Key words: electrical status epilepticus during slow sleep （ESES）, onset age of ESES, distribution of ESES, duration of ESES, SWI during wakefulness, therapeutic outcomes

中图分类号:

R742.1

王秀英,彭炳蔚,朱海霞,李小晶,宁书尧,陈文雄,冯芳媚. 儿童睡眠中癫痫性电持续状态脑电图特点与疗效的相关性[J]. 实用医学杂志, 2024, 40(4): 526-531.

Xiuying WANG,Bingwei PENG,Haixia ZHU,Xiaojing LI,Shuyao NING,Wenxiong CHEN,Fangmei. FENG. The correlation between EEG features and therapeutic effect in children with electrical status epilepticus during sleep[J]. The Journal of Practical Medicine, 2024, 40(4): 526-531.

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	一侧性ESES	双侧不对称ESES	多灶性ESES	局灶性ESES	合计	χ²值	P值
合计	12	18	14	6	50	22.35	0.001
ASeLECTs	7（21.2）	17（51.5）	8（24.2）	1（3.0）	33	13.499^a	0.002^a
NIFE	2（15.4）	1（7.7）	5（38.5）	5（38.5）	13	6.008^b	0.08^b
LKS	3（75.0）	0（0.0）	1（25.0）	0（0.0）	4	4.816^c	0.212^c

项目	良好组	控制组	无效组	合计	χ²值	P值
合计	24	13	13	50	15.619	0.016
①一侧性ESES	8	2	2	12	0.455^a 4.105^b 7.218^c	1.0^a 0.127^b 0.023^c
②双侧不对称ESES	13	2	3	18	5.8^d	0.049^d
③局灶性ESES	1	2	3	6	0.781^e	0.818^e
④多灶性ESES	2	7	5	14	11.026^f	0.003^f

项目	良好组	控制组	无效组	合计	χ²/F值	P值
合计	24	13	13	50	11.129	0.025
① ≤ 20%	17	6	2	25	8.148^a	0.017^a
②21% ~ 49%	4	5	6	15	0.637^b	0.876^b
③≥ 50%	3	2	5	10	7.262^c	0.016^c

	清醒期SWI指数	ESES持续时间（m）
出现ESES的年龄（y）	-0.304（0.032）	-0.435（0.002）
清醒期SWI指数	/	0.363（0.01）

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