本文選題：癲癇持續(xù)狀態(tài)(SE) + 連續(xù)部分性癲癇持續(xù)狀態(tài)(EPC)��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：癲癇持續(xù)狀態(tài)(SE)是神經(jīng)內(nèi)科最為常見(jiàn)的危急重癥,隨著大家對(duì)癲癇的認(rèn)識(shí)的加深,癲癇持續(xù)狀態(tài)的定義也在不斷完善中,2001年國(guó)際抗癲癇聯(lián)盟提出了新的癲癇持續(xù)狀態(tài)的定義:“一次癲癇發(fā)作(包括各種類(lèi)型癲癇發(fā)作)持續(xù)時(shí)間大大超過(guò)大多數(shù)這種發(fā)作類(lèi)型患者的發(fā)作時(shí)間,發(fā)作仍沒(méi)有停止的臨床征象,或反復(fù)的癲癇發(fā)作,在發(fā)作間期中樞神經(jīng)系統(tǒng)的功能沒(méi)有恢復(fù)到正�；�(xiàn)狀態(tài)”。持續(xù)的癲癇發(fā)作常合并感染、電解質(zhì)紊亂、酸堿平衡失調(diào)、多器官功能衰竭,導(dǎo)致難治性癲癇的發(fā)生,增加患者致殘率和死亡率。全面性癲癇持續(xù)狀態(tài)已得到臨床醫(yī)生高度重視,但對(duì)局灶性癲癇持續(xù)狀態(tài)認(rèn)識(shí)還不夠深入,一方面導(dǎo)致該疾病在早期沒(méi)有得到及時(shí)診斷和積極治療,患者常常留下嚴(yán)重的神經(jīng)功能障礙,如癲癇發(fā)作后神經(jīng)功能缺損(PEND);另一方面也可能存在過(guò)治療,導(dǎo)致呼吸抑制等并發(fā)癥。其中,連續(xù)部分性癲癇持續(xù)狀態(tài)(epilepsia partialis continua,EPC),又稱(chēng)Kojewnikow綜合征(KS),作為局灶性癲癇持續(xù)狀態(tài)的一種亞型越來(lái)越受到人們的關(guān)注。目的:分析總結(jié)Kojewnikow綜合征患者臨床、腦電、影像學(xué)特征,分析影響預(yù)后的相關(guān)因素,為Kojewnikow綜合征的預(yù)防、診斷、治療提供經(jīng)驗(yàn)。方法:回顧性分析于2013年9月1至2017年2月1日期間于我院(吉林大學(xué)中日聯(lián)誼醫(yī)院)就診的門(mén)診及住院的局灶性癲癇持續(xù)狀態(tài)病例,排除資料極不完善的病歷,進(jìn)一步結(jié)合其臨床癥狀及腦電圖改變,將符合2001年癲癇診斷及分類(lèi)標(biāo)準(zhǔn),且符合Thomas[1]提出的KS兩大特點(diǎn)的病例納入研究。詳細(xì)閱讀病歷資料,對(duì)部分患者進(jìn)行電話(huà)跟蹤隨訪(fǎng),分別記錄患者的性別、發(fā)病年齡、病因、誘因、發(fā)作累及部位、發(fā)作時(shí)合并癥狀、腦電圖改變、影像學(xué)檢查、一次發(fā)作持續(xù)時(shí)間、發(fā)作控制時(shí)間、治療方法、抗癲癇藥物及預(yù)后情況,總結(jié)KS的臨床、影像、腦電圖特征,并分析發(fā)病年齡、病因、誘因、腦電圖、影像學(xué)特征、意識(shí)狀態(tài)、一次發(fā)作持續(xù)時(shí)間、發(fā)作控制時(shí)間、發(fā)作頻率特點(diǎn)及抗癲癇治療對(duì)KS預(yù)后的影響。結(jié)果:1、臨床特征:男女比例為1.69:1,平均年齡(51.9±21.55)歲。以41-60歲中年組及大于60歲老年組最常見(jiàn),各占37.1%;病因以急性癥狀性及慢性癥狀性最常見(jiàn),各占了34.3%;感染及不規(guī)律應(yīng)用抗癲癇藥物是KS最常見(jiàn)的誘因;最常見(jiàn)的累及部位是面部、上肢及面部,各占20%,累及近端肢體多于遠(yuǎn)端肢體,左側(cè)多于右側(cè)。發(fā)作期間9例(25.7%)合并其他類(lèi)型癲癇發(fā)作;23例(65.7%)合并不同程度的意識(shí)障礙,其余12例(34.3%)發(fā)作期間意識(shí)清楚;26例(74.3%)表現(xiàn)為持續(xù)發(fā)作,9例(25.7%)表現(xiàn)為叢集發(fā)作。2、腦電圖特征:發(fā)作間期腦電圖:30例(85.7%)表現(xiàn)異常,其中10例(28.6%)為雙側(cè)異常,12例(34.3%)為右側(cè)異常,8例(22.6%)為左側(cè)異常,異常腦電圖主要以慢波為主(57.1%),局灶性慢波多見(jiàn);部分行發(fā)作期腦電圖,以肌陣攣對(duì)側(cè)出現(xiàn)周期性癲癇樣放電(PLEDs)常見(jiàn)。3、影像學(xué)特征:影像檢查異常者31例(88.6%),正常4例(11.4%),其中僅皮層異常者23例(65.7%),主要為額、頂皮層異常,僅皮下結(jié)構(gòu)異常者3例(8.6%),皮層及皮下結(jié)構(gòu)均異常者5例(14.3%)。右側(cè)異常更常見(jiàn)。對(duì)比臨床表現(xiàn)、腦電圖,60%具有相關(guān)性影像學(xué)改變,以額、頂葉皮質(zhì)受累最常見(jiàn)。4、治療及預(yù)后:大部分患者發(fā)作期應(yīng)用抗癲癇藥物,小部分病例自行好轉(zhuǎn)或去除病因后好轉(zhuǎn),22例(62.9%)患者聯(lián)合2種以上的抗癲癇藥物,其中最常見(jiàn)丙戊酸鈉靜脈給藥,其次是苯巴比妥肌注;除2例死亡及1例出院外,10例(31.2%)合并PEND,最常見(jiàn)的PEND是TODD麻痹。5、影響預(yù)后的相關(guān)因素分析:性別、發(fā)病年齡、病因、腦電圖、影像學(xué)檢查、一次發(fā)作持續(xù)時(shí)間、發(fā)作頻率特點(diǎn)、抗癲癇治療與是否合并PEND無(wú)關(guān)(P0.05),意識(shí)狀態(tài)、發(fā)作控制時(shí)間與是否合并PEND相關(guān)(P0.05)。結(jié)論:1、KS易發(fā)生于中老年癲癇患者中,感染及不規(guī)律應(yīng)用抗癲癇藥物是KS最常見(jiàn)的誘因,面部、上肢最常累及。額、頂葉皮層異常是KS危險(xiǎn)因素,發(fā)作間期腦電圖改變以局灶性慢波最常見(jiàn),提示腦局部功能異常。2、KS治療中大多數(shù)患者需要聯(lián)合2種以上抗癲癇藥物。部分KS遺留PEND,最常見(jiàn)的是TODD麻痹。3、意識(shí)狀態(tài)、發(fā)作控制時(shí)間可能影響預(yù)后,積極控制KS發(fā)作是改善預(yù)后的關(guān)鍵。
[Abstract]:The status epilepticus (SE) is the most common critical critical in the Department of Neurology. With the deepening of understanding of epilepsy, the definition of the status of epilepsy is constantly improved. In 2001, the international antiepileptic alliance proposed a new definition of the status of the status of epilepsy: "a seizure (including various types of epileptic seizures) has a great duration of duration. In most cases of this type of attack, the seizures still have no stopping clinical signs, or repeated seizures, and the function of the central nervous system is not restored to normal baseline in the interval of the seizure. Persistent seizures often merge infection, electrolyte disorder, acid-base balance disorder, multiple organ failure, resulting in difficult treatment. The occurrence of sexual epilepsy increases the rate of disability and mortality. The status of comprehensive epilepsy has been highly valued by clinicians, but the understanding of the persistent state of focal epilepsy is not enough. On the one hand, the disease has not been diagnosed and actively treated in the early stage, and the patients often leave serious neurological dysfunction, such as epilepsy. The post seizure nerve function defect (PEND), on the other hand, may also lead to complications such as respiratory depression, such as the continuous partial status epilepticus (epilepsia partialis continua, EPC), and Kojewnikow syndrome (KS). A subtype of focal status epilepticus is becoming more and more concerned. Summarize the clinical, electroencephalogram and imaging features of Kojewnikow syndrome patients, analyze the related factors affecting the prognosis, and provide experience for the prevention, diagnosis and treatment of Kojewnikow syndrome. Methods: retrospective analysis of the focal epilepsy in the outpatient and hospitalized patients in our hospital (Jilin University Sino Japan Friendship Hospital) from 1 to February 1, 2017 September 2013. Persistent cases, excluding the very incomplete data, further combined with the clinical symptoms and electroencephalogram changes, will conform to the 2001 epileptic diagnosis and classification standards, and conform to the Thomas[1] KS two characteristics of the case included in the study. Read the medical records in detail, follow up the patients by telephone follow-up and record the patient's sex, respectively. Age, cause, cause, cause, part of attack, combined symptoms, electroencephalogram change, imaging examination, one attack duration, time of seizure control, treatment, antiepileptic drugs and prognosis, summarize the clinical, imaging, Electroencephalogram Characteristics of KS, and analyze the age, cause, inducement, electroencephalogram, imaging features and meaning of the onset of disease. Status, duration of one attack, time of seizure control, frequency characteristics of seizures and the effect of antiepileptic therapy on KS prognosis. Results: 1, clinical features: the proportion of men and women was 1.69:1, the average age was (51.9 + 21.55) years, the most common in the 41-60 year old group and the older group older than 60 years, each accounted for 37.1%; the cause of the cause was acute symptomatic and chronic symptomatic most frequent. See, each accounted for 34.3%; infection and irregular use of antiepileptic drugs was the most common cause of KS; the most common areas involved were facial, upper and face, each accounted for 20%, involving the proximal extremities more than the distal extremities, and the left side more than the right. 9 cases (25.7%) combined with other types of epileptic seizures during the seizure; 23 cases (65.7%) combined different degrees of consciousness disorder, The other 12 cases (34.3%) had a clear consciousness during the seizure; 26 (74.3%) showed continuous seizures, 9 (25.7%) showed cluster attack.2, electroencephalogram (EEG) characteristics: interictal electroencephalogram (EEG): 30 cases (85.7%) were abnormal, 10 (28.6%) was bilateral abnormality, 12 (34.3%) was right abnormality, 8 cases (22.6%) were left abnormality, and abnormal electroencephalogram mainly was slow wave. Main (57.1%), focal slow waves were most common; part of the episodes of electroencephalogram (PLEDs) was common.3 in the contralateral myoclonus, imaging features: 31 cases (88.6%) with abnormal imaging examination (88.6%) and 4 normal cases (11.4%), of which there were only 23 cases (65.7%) with only cortical abnormalities, and 3 cases (8.6%), only hypodermic structures (8.6%), and skin. There were 5 cases (14.3%) with abnormal layer and subcutaneous structure. Abnormal right side was more common. Comparison of clinical manifestations, electroencephalogram, 60% associated imaging changes, the most common.4, treatment and prognosis in frontal cortex and parietal cortex: most of the patients were treated with antiepileptic drugs, small cases improved or removed the cause, and 22 cases (62.9%) were combined. 2 or more antiepileptic drugs, the most common valproate intravenous drug, followed by phenobarbital intramuscular injection; 2 cases of death and 1 cases of discharge, 10 cases (31.2%) combined with PEND, the most common PEND is TODD paralysis.5, affecting the prognosis of related factors analysis: sex, age, etiology, electroencephalogram, imaging examination, one attack duration, The characteristics of attack frequency, anti epileptic treatment and whether or not combining PEND (P0.05), consciousness state, seizure control time and PEND associated with (P0.05). Conclusion: 1, KS occurs easily in middle-aged and elderly epileptic patients, infection and irregular application of antiepileptic drugs are the most common cause of KS, the most frequently involved in the face, upper extremity. The abnormal of the parietal cortex is the KS danger. Risk factors, electroencephalogram changes in interictal period are the most common focal slow wave, suggesting that the local function of brain is abnormal.2, most of the patients in the KS treatment need to combine more than 2 antiepileptic drugs. Part of the KS remains PEND, the most common is the TODD paralytic.3, the state of consciousness, the seizure control time may affect the prognosis, and active control of KS seizures is the key to improving prognosis. Key.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R742.1

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