甲泼尼龙冲击对儿童睡眠中癫痫性电持续状态的疗效分析

发布时间：2018-05-30 08:57

  本文选题：儿童睡眠中癫痫性电持续状态 + 皮质类固醇激素　； 参考：《南昌大学》2012年硕士论文

【摘要】：目的：儿童睡眠期癫痫性电持续状态（electrical status epilepticus during sleep，ESES）是小儿时期一种特有的电现象，是指患者慢波睡眠期出现持续或几乎持续的局限性或广泛性棘慢波发放，通常以棘慢波指数（SWI）≥50%为标准。虽然仅占癫痫患儿的0.5%，但常常伴有神经心理学方面的损伤，甚至较癫痫发作更突出，其治疗的重点在于消除电持续状态。近来的研究报道表明，皮质类固醇激素治疗对消除电持续状态，改善神经心理学损伤有效果。由于ESES可在诸如CSWS、LKS、LGS、BECTS等多种癫痫综合征中合并发生，大多数类型常有严重的精神运动发育迟滞。其中BECTS合并ESES的患儿是其中预后最好的一种，便于进行认知方面的测定。本文选择了60例BECTS合并ESES的患儿，分别予以传统抗癫痫药物和甲泼尼龙冲击联用传统抗癫痫药物治疗，以评价甲泼尼龙冲击治疗ESES的临床疗效及对认知的影响。 方法：60例BECTS合并ESES的患儿，随机分为治疗组和对照组。治疗组给予甲泼尼龙序贯泼尼松治疗，具体为甲泼尼龙15~20mg/kg·d，连用3天，每周1个疗程，共3个疗程，之后予泼尼松1.5~2.0mg/kg·d，4~12周后减量，视病情维持疗程至4~6个月，期间维持患儿原有抗癫痫药物不变。对照组按照患儿个人发作类型不同给予丙戊酸钠、奥卡西平、托吡酯、左乙拉西坦、拉莫三嗪等药物治疗。并在治疗后6月时随访。治疗前后分别记录脑电图、行韦氏儿童智力测试，观察发作控制情况及药物不良反应，对比分析甲泼尼龙冲击疗法的疗效结果。结果以x±s表示，SPSS18.0统计软件进行统计分析，组间比较采用t检验。P＜0.05为有统计学意义。 结果： ①临床疗效治疗组30例中，发作控制7例，有效20例，，无效3例，总有效率90.0%；对照组30例中，发作控制6例，有效17例，无效7例，总有效率76.7%；两组临床疗效比较，差异无统计学意义(P0.05)。 ②脑电图变化治疗组30例中，有效25例，无效5例，有效率83.3%；对照组30例中，有效17例，无效13例，有效率56.7%；两组间脑电图治疗有效率经比较，差异有统计学意义（P0.05)。 ③认知功能变化分为4-6岁儿童组和6-15岁儿童组，两项分组中，治疗组与对照组用药前各项结果差异无统计学意义(P0.05)；治疗组用药6月后与治疗前相比较，言语智商（VIQ）、操作智商（PIQ）总智商（FIQ）均有增加（P0.05)；对照组治疗6月后与治疗前比较VIQ、FIQ、PIQ无明显差异(P0.05);用药6月后治疗组与对照组相比较，治疗组VIQ、PIQ、FIQ得分均高于对照组，有统计学意义(P0.05)。 ④不良反应激素治疗组可有因皮质激素引起的不良反应，且主要在激素治疗期间出现，包括感染8例（26.7%），体重增加、库欣面容30例（100%）、低钾血症1例（3.3%）。在激素减停后，上述不良反应均消失。随访6月间，治疗组观察到的不良反应率23.3%；对照组观察到的不良反应率为：26.7%；治疗组与对照组不良反应发生率比较，无统计学意义。 结论： 1、甲泼尼龙冲击治疗ESES，在临床发作控制方面效果与单用传统抗癫痫药物相似。 2、甲泼尼龙冲击治疗ESES与单用传统抗癫痫药物对于患儿脑电图的缓解均有效果，甲泼尼龙冲击治疗效果更显著。 3、甲泼尼龙冲击治疗对ESES患儿的认知能力有部分改善，而单用传统抗癫痫药物不能缓解患儿认知能力。 4、甲泼尼龙冲击治疗的特殊不良反应有感染、体重增加等，但停药后可消失，其他不良反应率相较单用传统抗癫痫药物的相当，无显著差异。
[Abstract]:Objective: electrical status epilepticus during sleep (ESES) in children's sleep period is a special electrical phenomenon in childhood. It refers to the persistent or almost continuous limited or widespread spinous wave distribution in the slow wave sleep period, usually with the einous wave index (SWI) more than 50% as the standard. Although only the epileptic patients are suffering from epilepsy. 0.5%, but often accompanied by neuropsychological damage, even more prominent than epileptic seizures, the focus of their treatment is to eliminate electrical persistence. Recent studies have shown that corticosteroid therapy has an effect on eliminating electrical persistence and improving neuropsychological damage. Because ESES can be used in such cases as CSWS, LKS, LGS, BECTS and so on. Most types often have severe psychomotor retardation in most types of epilepsy syndrome. Among them, children with BECTS combined with ESES are the best one with the best prognosis. In this paper, 60 children with BECTS combined with ESES were selected for traditional antiepileptic drugs and methylprednisolone impact combined with traditional resistance. Epileptic drug therapy was used to evaluate the clinical efficacy and cognitive effects of methylprednisolone pulse therapy on ESES.
Methods: 60 children with BECTS combined with ESES were randomly divided into the treatment group and the control group. The treatment group was treated with prednisolone with prednisolone, specific for methylprednisolone 15~20mg/kg. D, for 3 days, 1 courses per week, 3 courses of treatment, then prednisone 1.5~2.0mg/kg D, 4~12 weeks after 4~12, and maintained a course of treatment to 4~6 months, during the period of 4~6 months, during the period of maintenance. The control group was treated with sodium valproate, oxcarbazepine, topiramate, levetiracetam, lamotrigine and other drugs in accordance with the types of individual seizures in the children. The electroencephalogram was recorded before and after the treatment, and the Wechsler intelligence test was performed before and after the treatment to observe the seizure control and adverse drug reactions. The results of methylprednisolone impact therapy were compared and analyzed. The results were x + s, SPSS18.0 statistical software was statistically analyzed, and.P < 0.05 was statistically significant between groups using t test.
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