2011～2012年吉林大学第一医院儿童癫痫门诊就诊情况调查及随访

发布时间：2018-10-13 18:44

【摘要】：目的：通过总结我院一年间小儿神经科门诊癫痫患儿就诊和随访情况的调查，实现建立癫痫患儿数据库，完善对癫痫患儿的管理制度，提高患者的依从性，为癫痫的临床研究提供基本保证。方法：采用自制的癫痫患儿登记表对新确诊为癫痫及既往诊断为癫痫的患儿进行年龄、性别、体重、首次发病日期、确诊日期、发作形式、频率、有无诱发因素、体格检查、实验室检查、用药情况、治疗反应等进行登记及随访。癫痫发作分类采用1981年ILAE制定的标准，癫痫综合症分类采用2001年ILAE提出的新建议。结果： 1、建立了2011~2012年就诊癫痫病人的数据库。共收集癫痫病例为1082例（新诊断632例，既往诊断来随访450例），男孩618例，女孩464例。男女比例为1.33：1。 2、按照1981年ILAE癫痫发作的分类，诊断癫痫的患儿共898例，其中部分性发作768例，全身性发作118例，分类不明12例。根据2001年ILAE癫痫综合征的分类报告，癫痫综合征共184例，其中局灶性癫痫综合征76例，全面性癫痫综合征108例。 3、本研究中，单药治疗的有862例，两药联合的有186例，三药联合的有7例，四药联合2例，手术治疗1例，未用药治疗观察24例。 4、最长随访时间5年，，最短1个月。发作完全控制的750例，治疗显效的98例，有效的220例，未控制的14例；除外症状性癫痫，3年无发作，处于药物减量中120例（其中脑电图异常放电完全消失60例）；有4例药物减量中再次发作，加回原量。已停药1年后复发的有1例；依从性差，不规律服药、自行停药致再次发作的有10例；诊断难治性癫痫7例；脱落10例。 5、使用抗癫痫药物治疗的1054例患儿中，有72例出现不良反应，共出现105例次。 6、1082例确诊的癫痫患儿，进行24小时动态脑电图检查的1012例，普通脑电图的70例，其中脑电图异常放电的为962例，脑电图无异常放电的120例。用药治疗后复查动态脑电图的有764例，592例脑电图仍有异常，但放电较前减轻，有4例病程中出现发作反复，脑电图呈ESES现象。结论： 1、建立了2011~2012年间就医癫痫患儿的数据库，为癫痫的临床研究提供基本保证。 2、本中心2011~2012年间，共登记癫痫随访患儿1082例（新诊断632例；既往诊断450例）。男女比例1.33：1。按癫痫发作分类的有898例，按癫痫综合征分类的有184例。脑电图阳性率为88.9%。 3、病因学调查：查到病因诊断症状性癫痫的占27.2%；影像学异常占22.6%；有惊厥家族史的占4.8%。 4、在1082例癫痫病人中，最长随访时间5年，最短1个月，发作完全控制占69.3%，治疗显效占9.1%，有效占20.3%，无效占1.3%。其中依从性差及脱落人数各占0.9%。 5、药物相关的不良反应：抗癫痫药物治疗的1054例患儿中，有72例出现药物不良反应，占6.8%。
[Abstract]:Objective: to establish a database of children with epilepsy, improve the management system of children with epilepsy, and improve the compliance of children with epilepsy by summarizing the investigation and follow-up of the children with epilepsy in pediatric neurology outpatient clinic in one year, in order to establish the database of children with epilepsy, and to improve the compliance of the patients with epilepsy. To provide the basic guarantee for the clinical study of epilepsy. Methods: age, sex, body weight, date of first onset, date of diagnosis, form of seizure, frequency, inducing factors, physical examination, and physical examination were performed on the newly diagnosed and previously diagnosed children with epilepsy by self-made registration form of epileptic children. Laboratory examination, drug use, therapeutic response and so on were registered and followed up. The classification of epileptic seizures is based on the criteria established by ILAE in 1981, and the classification of epilepsy syndrome is based on the new recommendations made by ILAE in 2001. Results: 1. A database of epileptic patients from 2011 to 2012 was established. There were 1082 cases of epilepsy (632 cases of new diagnosis and 450 cases of follow-up). There were 618 cases of boys and 464 cases of girls. The ratio of male and female was 1.33: 1.2. According to the classification of ILAE seizures in 1981, there were 898 children with epilepsy, including 768 partial seizures, 118 systemic seizures and 12 unknown classification. According to the classification report of ILAE epilepsy syndrome in 2001, there were 184 cases of epilepsy syndrome, including 76 cases of focal epilepsy syndrome and 108 cases of comprehensive epilepsy syndrome. In this study, 862 cases were treated with single drug and 186 cases were treated with two drugs. 7 cases were combined with three drugs, 2 cases were combined with four drugs, 1 case was treated by surgery, 24 cases were observed without medication, the longest follow-up time was 5 years and the shortest month was 1 month. There were 750 cases with complete control of seizure, 98 cases with marked effect, 220 cases with effective treatment, 14 cases with uncontrolled seizure, 120 cases with no seizure in 3 years and 120 cases with drug reduction (60 cases of abnormal EEG discharges disappeared completely). There were 4 cases of reattack in the drug reduction and the addition of the original dose. There were 1 case of relapse after one year's withdrawal, 10 cases of poor compliance and irregular medication, 7 cases of refractory epilepsy, 10 cases of abscission, and 1054 cases of children treated with antiepileptic drugs. There were 72 cases of adverse reactions, including 105 cases of epileptic children, 1012 cases of 24 hour ambulatory electroencephalogram (AEEG) and 70 cases of general EEG, of which 962 cases were abnormal electroencephalogram (EEG) discharge. No abnormal discharge of EEG in 120 cases. After treatment, 764 patients were reexamined and 592 patients had abnormal EEG, but the discharge was lighter than before. There were 4 cases with repeated seizures in the course of the disease, and EEG showed ESES phenomenon. Conclusion: 1. The database of children with epilepsy from 2011 to 2012 was established to provide the basic guarantee for the clinical study of epilepsy. During the period of 2011 and 2012, 1082 cases of children with epilepsy were followed up (new diagnosis 632 cases); 450 cases were diagnosed. The ratio of men to women is 1.33: 1. There were 898 cases classified by epileptic seizures and 184 cases classified by epilepsy syndrome. The positive rate of electroencephalogram (EEG) was 88.9.3. The etiological investigation showed that the etiological diagnosis of symptomatic epilepsy accounted for 27.2%, the imaging abnormality accounted for 22.6%, the family history of convulsion was 4.8%, and the longest follow-up time was 5 years in 1082 epileptic patients. The shortest month was 1 month, complete control of attack accounted for 69.3%, curative effect accounted for 9.1%, effective accounted for 20.3%, invalid accounted for 1.3%. Of the 1054 children treated with antiepileptic drugs, 72 (6.8%) had adverse drug reactions.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.1

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