临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (8): 618-.doi: 10.3969/j.issn.1000-3606.2020.08.015

• 综合报道 • 上一篇    下一篇

单纯疱疹病毒性脑炎继发痉挛发作3 例分析并文献复习

万林, 杨光, 李志超, 孙于林, 石秀玉, 王静, 任蔚华, 邹丽萍   

  1. 解放军总医院第一医学中心儿内科(北京 100853)
  • 出版日期:2020-08-15 发布日期:2020-08-11
  • 通讯作者: 杨光 电子信箱:Email:yangg301@sina.com
  • 基金资助:
    国家自然科学基金面上项目(No.81671279);解放军总医院医疗大数据与人工智能研发项目(No.2019MBD-004)

Spasms after herpes simplex encephalitis :three cases and literature review

 WAN Lin, YANG Guang, LI Zhichao, SUN Yulin, SHI Xiuyu, WANG Jing, REN Weihua, ZOU Liping   

  1. Department of Pediatric, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Online:2020-08-15 Published:2020-08-11

摘要: 目的 探讨儿童单纯疱疹病毒性脑炎后并发痉挛发作的临床特征及治疗。方法 回顾分析3例单纯疱疹病 毒性脑炎后并发痉挛发作患儿的临床资料,并复习相关文献。结果 1例女性、 2例男性患儿,14~27月龄,均有婴儿期单 纯疱疹病毒性脑炎病史,出现痉挛发作时年龄均<1岁。头颅磁共振均可见明显异常,例1双颞顶叶多发异常信号,左颞顶 叶脑实质血肿;例2双侧顶叶及脑室旁多发异常信号;例3双侧颞叶、颞叶皮质区、嗅三角区、岛叶、左枕颞内侧回、双侧 枕叶、顶叶、右侧丘脑、右侧侧脑室体旁多发异常信号。例1和例2给予促皮质素(ACTH)治疗,例3行迷走神经刺激术并 结合抗癫痫药物治疗。例2短期缓解后复发,另2例均未缓解,治疗效果欠佳。以“单纯疱疹病毒性脑炎、癫痫、痉挛发作” 为关键词,在中国知网、万方数据库以及PubMed中进行搜索,共获得英文文献3篇,20例患儿,在长期随访中均发展为药 物难治性癫痫,预后不佳。结论 单纯疱疹病毒性脑炎后并发痉挛发作,药物治疗效果较差,预后不佳。

关键词:  单纯疱疹病毒性脑炎; 痉挛发作; 治疗

Abstract:  Objective To investigate the clinical features and diagnosis and treatment of spams after herpes simplex encephalitis. Methods The clinical data of three cases of herpes simplex encephalitis complicated with spasm were retrospectively analyzed, and “herpes simplex encephalitis” “seizures” “spasms” as the keywords were searched on PubMed, CNKI, Wanfang Medical Online and the relevant literatures were reviewed. Results Three cases of children had a history of childhood herpes simplex viral encephalitis and spasms onset in the infancy stage. The brain MRI showed abnormality. Patient 1 and 2 treated with ACTH showed partial seizure control. Patient 3 received the vagal nerve stimulation. Patient 2 recurred after short-term remission. All the three patients had seizures during the follow-up, and the therapeutic effect was poor. With "herpes simplex encephalitis, epilepsy, spasmodic seizures" as the key words, a total of 3 English literatures were searched on CNKI, Wanfang database and PubMed, 20 children with long-term follow-up were found to have developed into drug-refractory epilepsy with poor prognosis. Conclusion The drug treatment effect and prognosis of spasms after herpes simplex encephalitis is poor.

Key words:  herpes simplex encephalitis; spasms; treatment