儿童癫痫的影像学检查、脑电图改变及治疗效果的相关性研究

发布时间：2018-06-23 20:03

本文选题：儿童 + 癫痫　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：对我院神经内科门诊和住院确诊为癫痫患儿的头颅影像学（MRI、CT）、EEG等辅助检查和药物治疗等情况进行综合回顾性分析，以初步探讨其头颅影像学检查结果、脑电图改变情况和药物治疗效果的相关性。方法：通过收集2011年8月至2013年1月在重庆医科大学附属儿童医院神经内科专科门诊和住院部，通过临床发作、头颅影像学和脑电图检查确诊为癫痫，并规律服用抗癫痫药物（AEDs）的106例患儿的临床资料，，进行随访。入组时106例患儿均行EEG检查、头颅MRI（或头颅CT）检查。随访时间为用药后至少6月，至少随访3次，随访内容为AEDs治疗后患儿癫痫发作控制情况、EEG、MRI等辅助检查的改变、药物毒副反应等情况。治疗效果以癫痫发作控制情况评定。结果：初期入组114例，除外失访8例，最终入组106例，其中包括自行停药12例、死亡3例。男61例，女45例，年龄1月-12岁，平均5.02±3.71岁。疗效以临床发作控制情况为标准，分为有效控制（完全控制+部分控制）和无效控制。分组分析结果：1.根据头颅影像学检查结果分为影像学正常组（A1组）67例、异常组（A2组）39例，两组疗效之间比较差异具有显著性（χ2=6.47, P0.05）；2.根据脑电图检查结果分为脑电图正常组（B1组）11例、异常组（B2组）95例，两组疗效之间比较无明显差异（P0.05）；3.根据头颅影像学和脑电图检查结果分为影像学+脑电图异常组（C1组）38例、影像学+脑电图非完全异常组（C2组）68例，两组疗效之间比较差异具有显著性（χ2=7.15，P0.05）。4.根据随访后复查脑电图改变情况又分为脑电图恢复正常组（D1组）45例、脑电图持续异常组（D2组）61例，两组疗效之间比较有显著性差异（χ2=10.33，P0.05）。5.根据随访后患儿服用AEDs有无明显毒副反应的情况，分为无毒副反应组（E1组）86例，有毒副反应组（E2组）20例，两组疗效之间比较无差异（P0.05）。目前仍有92例保留治疗，保留治疗率为80.70%。结论：（1）头颅影像学（MRI、CT等）异常是影响儿童癫痫治疗效果的重要因素，头颅影像学检查异常者其疗效低于正常者。（2）EEG持续异常也是影响儿童癫痫治疗效果的重要因素，EEG持续异常者其疗效低于恢复正常者。（3）MRI/CT、EEG均异常者，其疗效较无明显异常者更差。（4）目前AEDs治疗儿童癫痫的整体疗效较好，不同类型的AEDs在治疗儿童癫痫时具有良好的耐受性及较高的保留治疗率，且儿童使用抗癫痫药物后的毒副反应相对较轻。
[Abstract]:Objective: to study the results of cranial imaging (MRICT) EEG and drug therapy in children with epilepsy diagnosed in outpatient and inpatient department of neurology in our hospital. The correlation between EEG changes and the effect of drug therapy. Methods: from August 2011 to January 2013, patients with epilepsy were diagnosed by clinical seizures, cranial imaging and electroencephalogram in the Department of Neurology, Department of Neurology, affiliated Children's Hospital of Chongqing Medical University. The clinical data of 106 children with regular antiepileptic drugs (AEDs) were followed up. EEG and cranial MRI (or CT) were performed in 106 children. The follow-up time was at least 6 months after treatment, and at least 3 times. The contents of follow-up were the changes of EEGG MRI and the side effects of drugs in children with epilepsy after AEDs treatment. The therapeutic effect was evaluated by epileptic seizure control. Results: there were 114 cases in the initial group, except 8 cases of lost visit, and 106 cases in the final group, including 12 cases of self-withdrawal and 3 cases of death. There were 61 males and 45 females, aged from 1 month to 12 years (mean 5.02 卤3.71 years). The curative effect is divided into effective control (complete control partial control) and ineffective control according to clinical seizure control. The result of the grouping analysis was: 1. According to the results of cranial imaging, 67 cases of normal imaging group (A1 group) and 39 cases of abnormal group (A2 group) were divided into two groups. There was significant difference between the two groups (蠂 2 6.47, P0.05). According to the results of EEG examination, 11 cases were divided into normal EEG group (B1 group) and 95 cases abnormal group (B2 group). There was no significant difference between the two groups (P0.05). According to the results of brain imaging and EEG examination, 38 patients were divided into abnormal EEG group (C1 group) and 68 patients with incomplete abnormal EEG (C2 group). There was significant difference between the two groups (蠂 2 7.15P 0.05). According to the changes of EEG after follow-up, 45 patients were divided into normal EEG group (D1 group) and 61 patients with persistent abnormal EEG (D2 group). There was significant difference between the two groups (蠂 2 10.33 P 0.05). According to the results of follow-up, the children were divided into two groups: no side effect group (E 1 group, n = 86) and no side effect group (E 2 group, n = 20). There was no significant difference between the two groups (P0.05). At present, there are 92 cases of retention therapy, the retention rate is 80.70%. Conclusion: (1) abnormal cranial imaging (MRII-CT, etc.) is an important factor affecting the therapeutic effect of epilepsy in children. (2) continuous abnormal EEG is also an important factor affecting the therapeutic effect of epilepsy in children. (3) patients with abnormal EEG are lower than those who return to normal. (3) patients with abnormal MRI / CTE EEG are all abnormal. The efficacy of AEDs is worse than that of those without obvious abnormalities. (4) the overall efficacy of AEDs in the treatment of childhood epilepsy is better. Different types of AEDs have good tolerance and high retention rate in the treatment of childhood epilepsy. The side effects of antiepileptic drugs in children were relatively mild.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

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