伴中央颞区棘波儿童癫痫药物治疗疗效分析

发布时间：2018-04-23 01:13

本文选题：BECT + EEG　；参考：《郑州大学》2012年硕士论文

【摘要】：背景伴中央颞区棘波的儿童癫痫(BECT)是一种最常见的儿童良性部分性癫痫,患病率为1：1000,病因尚未查明,可能与遗传相关,患儿发作多在非快速动眼睡眠(NREM)中,如刚入睡或快睡醒时。脑电图可见中央区和颞区局限性放电,随着患儿年龄增长,放电亦可扩散至额部或枕部。目前,抗癫痫药物是治疗该病最主要的方法,多数病例单药治疗即可获得良好的疗效,部分患儿须经加用其他药物后,发作才能得到控制,但并不是任何一种药物均能发挥作用,少数病例对3种以上抗癫痫药物都不敏感,因此有必要对各种抗癫痫药物的疗效进行对比,以寻找对该类型癫痫患儿最理想的药物。 BECT在癫痫治疗中会出现3种转归：1)临床症状消失,脑电图正常；2)临床症状消失,脑电图异常；3)发作未得到控制,脑电图异常。研究认为在上述3种转归中,第1种最常见,发病年龄较大,第2种次之,发病年龄偏小,第3中最少见。但我们在临床上发现,第2种转归更普遍,且多数患儿服用抗癫痫药物至少2年,甚至长达5年后,复查脑电图仍然异常,这些患儿经添加其他抗癫痫药物或增加原有的抗癫痫药物剂量1个月后再次复查脑电图时,发现脑电图中痫样放电较以前有明显好转。控制良好的BECT患儿复查脑电图的结果是否与其所服用的抗癫痫药物的种类或者剂量有关,目前国内尚缺乏这方面的报道。目的探讨BECT患儿的抗癫痫药物的疗效；对BECT患儿治疗前后的脑电图进行对比,分析其与药物剂量及药物的种类的相关性。方法对142例新诊断的BECT患儿进行2年以上的随访观察,填写癫痫患者登记表,对他们的发作形式、用药情况、家族史、既往史、热惊史、新生儿期病史及CT或MRI检查结果等重点记录。对其脑电图表现和临床治疗进行回顾性分析。结果 1、142例BECT患儿平均发病年龄为8±4.47(1-15岁),男女之比为2.2：1。研究组中,有36例为具有明确病因的症状性癫痫,106例为特发性癫痫,对两组患者的年龄分布采用两独立样本t检验进行,说明症状性癫痫和隐源性癫痫患者年龄存在差别(P=0.010.05),且症状性癫痫发病年龄较特发性癫痫早。 2、在BECT的病因调查中,排名前三位的分别是家族史(17.2%),热惊史(12.7%)和出生时窒息史(9.2%)。 3、142例病人中,有31例合并影像学异常表现的BECT患儿,其中5例为结节性硬化,可能与中央颞区放电存在某种程度的联系,剩余26例病变部位与中央颞区放电无明显联系。31例患者接受抗癫痫治疗后,有20例得到完全控制,提示这些颅内病变可能与BECT仅仅存在并存关系,对BECT的病程影响较小。 4、142例患儿以往均未用过抗癫痫药物,共有97(68.3%)例患者在服用第一种抗癫痫药物后,发作即得到控制,其中丙戊酸类(VPA)44例,托吡酯(TPM)4例,奥卡西平(OXC)43例,拉莫三嗪(LTG)6例,采用卡方检验,X2=14.277,P0.05发现OXC的首药发作控制率优于VPA,而与LTG组比较均无统计学意义。 5、142例患者中单药治疗者114例,多药治疗者28例,其中VPA+LTG8例,7例得到完全控制。两组病人的发病年龄采用两组独立样本的秩和检验,PO.005；提示单药治疗和联合治疗组的患者年龄存在明显差异。单药治疗组19例合并颅内结构性异常,多药治疗组12例合并颅内结构性异常；两组比较Z2=9.036,P=O.003,提示单药组及多药组合并颅内结构性异常存在显著性差异。 6、在142例BECT患儿中,42例(18例服用VPA,21例服用OXC,3例服用LTG)发作得到完全控制的患者治疗前后均接受24小时视频脑电监测,对VPA、OXC、LTG的药物剂量及患儿复查脑电图结果正常与否进行两独立样本t检验,VPA及OXC药物剂量对脑电图结果正常与否无明显影响(二者P值均大于0.05),LTG样本例数虽然较少,但仍从侧面反映了脑电图的结果是否正常与LTG的药物剂量无关。再对服用VPA后复查脑电图正常率与服用OXC复查脑电图正常率进行对比,X2=7.392,P=0.0070.05,提示服用VPA对脑电图的改善情况优于OXC。结论 1、BECT患儿具有明显的年龄依赖性外显, 2、BECT的病因主要为热惊史和出生时窒息史,且与家族史有一定的相关性, 3、OXC的首药发作控制率优于VPA, 4、单药治疗组和多药治疗组患者的年龄存在差异,多药治疗组患者年龄偏小。对于合并颅内结构性异常的患者,一般需要多药治疗才能控制病情。多药治疗中,VPA+LTG可获得较好疗效, 5、药物剂量对脑电图结果无明显影响,VPA对脑电图的改善情况优于OXC
[Abstract]:background
Children with epilepsy (BECT) with central temporal spinous waves is the most common benign partial epilepsy in children. The incidence of epilepsy is 1:1000. The etiology has not been identified. It may be related to heredity. The seizures in children are mostly in non rapid eye sleep (NREM), such as sleep or fast sleep. Electroencephalogram can be seen in the central and temporal area limited discharge, with the age of children. The discharge can also spread to the frontal or occipital parts. At present, antiepileptic drugs are the most important methods for the treatment of the disease. In most cases, single drug treatment can achieve good results. Some children must be treated with other drugs, but the seizures can be controlled, but not any one of them can play a role and a few cases have more than 3 antiepileptic cases. Epilepsy drugs are not sensitive, so it is necessary to compare the efficacy of various antiepileptic drugs in order to find the most ideal drug for children with this type of epilepsy.
In the treatment of BECT, there will be 3 types of outcome in the treatment of epilepsy: 1) disappearance of clinical symptoms, normal electroencephalogram, 2) disappearance of clinical symptoms, abnormal electroencephalogram, 3) uncontrolled seizures and abnormal electroencephalogram. In the study, first of the 3 changes are the most common, age of onset is larger, and second times are the least. But we are in the presence of third. It was found in bed that the second changes were more common, and most of the children were taking antiepileptic drugs for at least 2 years, even after 5 years. The reexamination of electroencephalogram was still abnormal. The epileptiform discharge in the EEG was better than before by adding other antiepileptic drugs or increasing the original antiepileptic drug dosage for 1 months. Whether the results of a well controlled BECT child reexamination of the EEG results are related to the type or dose of antiepileptic drugs they are taking, and there are still lack of reports in this area.
objective
To investigate the efficacy of antiepileptic drugs in children with BECT, and to compare the electroencephalogram of children with BECT before and after treatment, and to analyze the correlation between the drug dosage and the types of drugs.
Method
142 newly diagnosed children with BECT were followed up for more than 2 years, and the registration forms of epileptic patients were filled in. Their attack forms, drug use, family history, past history, history of heat shock, the history of neonatal period and the results of CT or MRI examination were recorded. The electroencephalogram and clinical treatment were reviewed.
Result
The average age of the 1142 children with BECT was 8 + 4.47 (1-15 years). In the 2.2:1. study group, 36 cases were symptomatic epilepsy with definite etiology, 106 cases were idiopathic epilepsy. The age distribution of two groups was examined by two independent sample t test, indicating the difference of age between symptomatic epilepsy and cryptogenic epilepsy (P=0.0 10.05), and the onset age of symptomatic epilepsy is earlier than that of idiopathic epilepsy.
2, in the etiological survey of BECT, the top three were family history (17.2%), heat shock history (12.7%) and birth asphyxia (9.2%).
Of the 3142 patients, there were 31 cases of BECT with abnormal imaging, 5 of which were nodular sclerosis, may be associated with the discharge of the central temporal region to some extent, and the remaining 26 cases were not associated with the discharge of the central temporal region. After the treatment of antiepileptic treatment, 20 cases were fully controlled, suggesting these intracranial lesions. It may exist only with BECT, but has little effect on the course of BECT.
4142 cases had not used antiepileptic drugs in the past, and 97 (68.3%) cases were controlled after the first antiepileptic drug, including 44 cases of valproic acid (VPA), 4 cases of topiramate (TPM), 43 cases of OXC (OXC), and 6 cases of lamotrigine (LTG), using chi square test, X2=14.277, and P0.05 to find that the attack control rate of OXC's first drug was better than VP. A, but compared with group LTG, there was no statistical significance.
Among the 5142 patients, there were 114 cases of single drug treatment and 28 cases of multidrug therapy, of which VPA+LTG8 cases and 7 cases were completely controlled. The age of two groups used rank sum test of two groups of independent samples, PO.005, suggesting that the age of the patients in the single drug treatment group and the combined treatment group was significantly different. 19 cases in the single drug treatment group were combined with intracranial structural abnormalities, more than one drug treatment group. There were 12 cases of intracranial structural abnormalities in the drug treatment group, and the two groups were compared with Z2=9.036, P=O.003. There were significant differences between the single drug group and the multidrug combination and the intracranial structural abnormalities.
6, of the 142 children with BECT, 42 cases (18 cases of VPA, 21 cases of OXC, 3 cases of LTG) were fully controlled before and after treatment with 24 hours video EEG monitoring. The dosage of VPA, OXC, LTG, and the children's EEG results were examined in two independent sample t test, and VPA and OXC drug dose on EEG results were positive. There was no obvious influence (the two P values were more than 0.05). Although the number of LTG samples was less, it still reflected that the results of electroencephalogram were not related to the dose of LTG. The ratio of the normal rate of electroencephalogram and the normal rate of electroencephalogram after taking OXC after taking VPA was compared, X2=7.392, P=0.0070.05, suggesting taking VPA to electroencephalogram. The improvement is better than the OXC.
conclusion
1, children with BECT had obvious age dependent appearance.
2, the causes of BECT are mainly heat shock and asphyxia at birth, and are related to family history.
3, OXC's first drug attack control rate was better than that of VPA.
4, the age of the patients in the single drug treatment group and the multidrug treatment group is different, and the age of the multidrug treatment group is small. For the patients with the intracranial structural abnormalities, the multidrug therapy is generally needed to control the condition. In the multidrug treatment, VPA+LTG can obtain a better curative effect.
5, the dose of drugs had no significant effect on EEG, and the improvement of EEG by VPA was better than OXC.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.1

【参考文献】