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目的探讨孤独症合并癫患儿的临床、脑电图(EEG)特征及治疗效果。方法对56例孤独症合并癫患儿应用抗癫药物治疗,治疗前后行EEG检查,观察其预后,并对临床特点及EEG进行分析。结果孤独症合并癫患儿中,癫发作类型以局限性发作最为常见(75%),其中63%是复杂局限性发作。其他较常见的发作形式是强直性发作(36%)和热性惊厥(27%),强直-阵挛性发作、失张力发作、不典型失神发作等发作形式也可出现。EEG主要表现为阵发性异常,包括背景活动减慢、阵发性快活动、阵发性δ活动、阵发性θ活动等非特异改变10例,以及局灶性、多灶性、弥散性尖(棘)波、尖(棘)慢波活动等性放电46例,其中位于颞叶26例(46%),额叶10例(18%),中央区9例(16%),枕叶6例(10%)。病变部位双侧局灶性29例(52%),单侧局灶性19例(34%),弥散性异常改变8例(14%)。经正规抗癫治疗,77%的病例获得1 a以上无发作控制效果,其中63%单药治疗有效,37%的患儿联合用药有效,23%的患儿未能获得控制。结论孤独症合并癫患儿存在不同类型的癫发作形式,局限性发作为其最常见的发作形式,大部分为复杂局限性发作。EEG主要表现为阵发性异常,部分出现癫样放电,EEG异常多起源于颞叶,多双侧出现。抗癫药物对于这类患者的癫发作有很好的控制效果,与其他原因所致癫治疗效果类似。
Objective To investigate the clinical features and therapeutic effects of EEG in children with autism and epilepsy. Methods Fifty - six children with autism and epilepsy were treated with antiepileptic drugs. EEG examination was performed before and after treatment. The prognosis was observed. The clinical features and EEG were analyzed. Results Among the children with autism and epilepsy, the most common type of epileptic seizure was localized attack (75%), of which 63% were complicated and localized. Other more common forms of seizures are tonic episodes (36%) and febrile seizures (27%), and episodes of tonic-clonic seizures, diastolic seizures, and atypical seizures can also occur. EEG mainly manifested as paroxysmal abnormalities, including background activity slowed, paroxysmal rapid activity, paroxysmal δ activity, paroxysmal θ activity and other non-specific changes in 10 cases, as well as focal, multifocal, diffuse 46 cases were located in the temporal lobe (46%), 10 cases (18%) of the frontal lobe, 9 cases (16%) of the central lobe, occipital lobe 6 cases (10%). Bilateral focal lesions in 29 cases (52%), unilateral focal in 19 cases (34%), diffuse abnormal changes in 8 cases (14%). After formal anti-epilepsy treatment, 77% of the patients received more than 1 year of seizure-free control, of which 63% were single-drug treatment effective, 37% of children combined with drug effective, 23% of children failed to gain control. Conclusions There are different types of epileptic seizures in children with autism and epilepsy. The most common seizures are their localized seizures, and most of them are complicated and limited seizures. EEG mainly manifested as paroxysmal anomalies, partial epileptiform discharges, EEG abnormalities mostly originated in the temporal lobe, appear more on both sides. Antiepileptic drugs have a very good control of epileptic seizures in these patients, similar to epilepsy with other causes.