本文選題：BECT + EEG　； 參考：《鄭州大學(xué)》2012年碩士論文

【摘要】：背景 伴中央顳區(qū)棘波的兒童癲癇(BECT)是一種最常見的兒童良性部分性癲癇,患病率為1：1000,病因尚未查明,可能與遺傳相關(guān),患兒發(fā)作多在非快速動眼睡眠(NREM)中,如剛?cè)胨蚩焖褧r。腦電圖可見中央?yún)^(qū)和顳區(qū)局限性放電,隨著患兒年齡增長,放電亦可擴(kuò)散至額部或枕部。目前,抗癲癇藥物是治療該病最主要的方法,多數(shù)病例單藥治療即可獲得良好的療效,部分患兒須經(jīng)加用其他藥物后,發(fā)作才能得到控制,但并不是任何一種藥物均能發(fā)揮作用,少數(shù)病例對3種以上抗癲癇藥物都不敏感,因此有必要對各種抗癲癇藥物的療效進(jìn)行對比,以尋找對該類型癲癇患兒最理想的藥物。 BECT在癲癇治療中會出現(xiàn)3種轉(zhuǎn)歸：1)臨床癥狀消失,腦電圖正常；2)臨床癥狀消失,腦電圖異常；3)發(fā)作未得到控制,腦電圖異常。研究認(rèn)為在上述3種轉(zhuǎn)歸中,第1種最常見,發(fā)病年齡較大,第2種次之,發(fā)病年齡偏小,第3中最少見。但我們在臨床上發(fā)現(xiàn),第2種轉(zhuǎn)歸更普遍,且多數(shù)患兒服用抗癲癇藥物至少2年,甚至長達(dá)5年后,復(fù)查腦電圖仍然異常,這些患兒經(jīng)添加其他抗癲癇藥物或增加原有的抗癲癇藥物劑量1個月后再次復(fù)查腦電圖時,發(fā)現(xiàn)腦電圖中癇樣放電較以前有明顯好轉(zhuǎn)。控制良好的BECT患兒復(fù)查腦電圖的結(jié)果是否與其所服用的抗癲癇藥物的種類或者劑量有關(guān),目前國內(nèi)尚缺乏這方面的報道。 目的 探討B(tài)ECT患兒的抗癲癇藥物的療效；對BECT患兒治療前后的腦電圖進(jìn)行對比,分析其與藥物劑量及藥物的種類的相關(guān)性。 方法 對142例新診斷的BECT患兒進(jìn)行2年以上的隨訪觀察,填寫癲癇患者登記表,對他們的發(fā)作形式、用藥情況、家族史、既往史、熱驚史、新生兒期病史及CT或MRI檢查結(jié)果等重點記錄。對其腦電圖表現(xiàn)和臨床治療進(jìn)行回顧性分析。 結(jié)果 1、142例BECT患兒平均發(fā)病年齡為8±4.47(1-15歲),男女之比為2.2：1。研究組中,有36例為具有明確病因的癥狀性癲癇,106例為特發(fā)性癲癇,對兩組患者的年齡分布采用兩獨立樣本t檢驗進(jìn)行,說明癥狀性癲癇和隱源性癲癇患者年齡存在差別(P=0.010.05),且癥狀性癲癇發(fā)病年齡較特發(fā)性癲癇早。 2、在BECT的病因調(diào)查中,排名前三位的分別是家族史(17.2%),熱驚史(12.7%)和出生時窒息史(9.2%)。 3、142例病人中,有31例合并影像學(xué)異常表現(xiàn)的BECT患兒,其中5例為結(jié)節(jié)性硬化,可能與中央顳區(qū)放電存在某種程度的聯(lián)系,剩余26例病變部位與中央顳區(qū)放電無明顯聯(lián)系。31例患者接受抗癲癇治療后,有20例得到完全控制,提示這些顱內(nèi)病變可能與BECT僅僅存在并存關(guān)系,對BECT的病程影響較小。 4、142例患兒以往均未用過抗癲癇藥物,共有97(68.3%)例患者在服用第一種抗癲癇藥物后,發(fā)作即得到控制,其中丙戊酸類(VPA)44例,托吡酯(TPM)4例,奧卡西平(OXC)43例,拉莫三嗪(LTG)6例,采用卡方檢驗,X2=14.277,P0.05發(fā)現(xiàn)OXC的首藥發(fā)作控制率優(yōu)于VPA,而與LTG組比較均無統(tǒng)計學(xué)意義。 5、142例患者中單藥治療者114例,多藥治療者28例,其中VPA+LTG8例,7例得到完全控制。兩組病人的發(fā)病年齡采用兩組獨立樣本的秩和檢驗,PO.005；提示單藥治療和聯(lián)合治療組的患者年齡存在明顯差異。單藥治療組19例合并顱內(nèi)結(jié)構(gòu)性異常,多藥治療組12例合并顱內(nèi)結(jié)構(gòu)性異常；兩組比較Z2=9.036,P=O.003,提示單藥組及多藥組合并顱內(nèi)結(jié)構(gòu)性異常存在顯著性差異。 6、在142例BECT患兒中,42例(18例服用VPA,21例服用OXC,3例服用LTG)發(fā)作得到完全控制的患者治療前后均接受24小時視頻腦電監(jiān)測,對VPA、OXC、LTG的藥物劑量及患兒復(fù)查腦電圖結(jié)果正常與否進(jìn)行兩獨立樣本t檢驗,VPA及OXC藥物劑量對腦電圖結(jié)果正常與否無明顯影響(二者P值均大于0.05),LTG樣本例數(shù)雖然較少,但仍從側(cè)面反映了腦電圖的結(jié)果是否正常與LTG的藥物劑量無關(guān)。再對服用VPA后復(fù)查腦電圖正常率與服用OXC復(fù)查腦電圖正常率進(jìn)行對比,X2=7.392,P=0.0070.05,提示服用VPA對腦電圖的改善情況優(yōu)于OXC。 結(jié)論 1、BECT患兒具有明顯的年齡依賴性外顯, 2、BECT的病因主要為熱驚史和出生時窒息史,且與家族史有一定的相關(guān)性, 3、OXC的首藥發(fā)作控制率優(yōu)于VPA, 4、單藥治療組和多藥治療組患者的年齡存在差異,多藥治療組患者年齡偏小。對于合并顱內(nèi)結(jié)構(gòu)性異常的患者,一般需要多藥治療才能控制病情。多藥治療中,VPA+LTG可獲得較好療效, 5、藥物劑量對腦電圖結(jié)果無明顯影響,VPA對腦電圖的改善情況優(yōu)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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R742.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄧大麗;余鋒;喻廉;劉會林;徐莉;;65例伴有中央顳區(qū)棘波的小兒良性癲癇(BECT)臨床預(yù)后觀察[J];安徽醫(yī)學(xué);2011年09期

2 束曉梅;張貴萍;楊冰竹;李磊;;兒童Rolandic癲vN伴睡眠期癲vN性電持續(xù)狀態(tài)4例臨床分析[J];中國當(dāng)代兒科雜志;2011年04期

3 陳春紅,吳滬生;伴中央-顳區(qū)棘波兒童良性癲vN的研究進(jìn)展[J];國外醫(yī)學(xué)(兒科學(xué)分冊);2004年S1期

4 董靜靜;劉曉燕;;兒童Rolandic放電的臨床研究進(jìn)展[J];國際兒科學(xué)雜志;2006年02期

5 李娜;林衛(wèi)紅;孟紅梅;崔俐;王贊;張淑琴;;奧卡西平單藥及聯(lián)合用藥治療部分性癲癇發(fā)作23例療效分析[J];吉林醫(yī)學(xué);2008年19期

6 康慧聰;朱遂強(qiáng);李衛(wèi)華;許峰;胡琦;茍玉蘭;阮旭中;;長程腦電圖在癲沲診斷與鑒別診斷中的價值[J];臨床神經(jīng)病學(xué)雜志;2006年04期

7 董靜靜;劉曉燕;;兒童及青少年中央顳區(qū)放電的臨床分析[J];臨床神經(jīng)電生理學(xué)雜志;2006年06期

8 陶拓宇;逯恒東;李樂加;;伴中央-顳部棘波的兒童良性癲沲25例抗癲沲治療結(jié)局的初步觀察[J];臨床神經(jīng)電生理學(xué)雜志;2008年05期

9 吳濤,付偉,許超,聶宇,周虹;兒童腦萎縮并發(fā)癲癇的護(hù)腦及抗癲癇治療效果[J];實用醫(yī)藥雜志;2002年09期

10 史良;單基因遺傳在特發(fā)性癲癇發(fā)病過程中的機(jī)制研究[J];山西醫(yī)藥雜志;2004年01期

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