儿童特发性和症状性枕叶癫痫临床分析

doi:10.12372/jcp.2023.22e1059

摘要/Abstract

摘要：

目的探讨儿童特发性与症状性枕叶癫痫的临床特征及治疗情况。方法回顾性分析2013年4月至2022年4月确诊为枕叶癫痫患儿的临床资料，患儿分为特发性组（包括早发型、晚发型）和症状性组，分别对其临床特点、辅助检查结果及治疗进行比较。结果纳入80例枕叶癫痫患儿，女28例、男52例，中位发病年龄7.0（5.0~7.0）岁，中位病程1.7（1.0~2.5）年。其中早发型组38例，晚发型组24例，症状性组18例。三组间发病年龄，发作时出现头眼偏转、自主神经症状、视幻觉、眼球阵挛、眼睑扑动、跌倒比例，检查发现视力异常、神经系统阳性体征比例差异均有统计学意义（P<0.05）;三组间智力测验分数低于正常及头颅MRI异常比例，发作间期脑电图如背景异常、双侧枕区放电、闭眼敏感发生率差异均有统计学意义（P<0.05）;三组间抗癫痫治疗、单药治疗比例，以及丙戊酸钠、左乙拉西坦、托吡酯使用率的差异均有统计学意义（P<0.05）。结论特发性和症状性枕叶癫痫患儿临床特征存在差异，需依据临床发作形式、头颅影像学特点及脑电图特征综合评估，制定相应的治疗方案。

关键词: 特发性枕叶癫痫, 症状性枕叶癫痫, 临床特征, 治疗, 儿童

Abstract:

Objective To investigate the clinical characteristics and treatment of idiopathic and symptomatic occipital lobe epilepsy in children. Methods The clinical data of children with occipital lobe epilepsy diagnosed from April 2013 to April 2022 were retrospectively analyzed. The patients were divided into idiopathic group (including early-onset group and late-onset group) and symptomatic group. The clinical characteristics, auxiliary examination results and treatment were compared between the groups. Results A total of 80 children (28 girls and 52 boys) with occipital lobe epilepsy were included. The median age of onset was 7.0 (5.0-7.0) years old and the median course of disease was 1.7 (1.0-2.5) years. There were 38 children in the early-onset group, 24 in the late-onset group and 18 in the symptomatic group. The age of onset, the proportion of head eye deflection, autonomic nervous symptoms, visual hallucinations, eye clonus, eyelid flutter and falls, and the proportion of abnormal vision and nervous system positive signs during physical examination existed significant differences among the three groups (P<0.05). The proportion of intelligence test score below normal and head MRI abnormalities, and the incidence of abnormal background, bilateral occipital discharge and eye closure sensitivity in the interictal electroencephalogram (EEG) were significantly different among three groups (P<0.05). There were statistically significant differences in the proportion of antiepileptic therapy, monotherapy and the utilization rate of sodium valproate, levetiracetam and topiramate among the three groups (P<0.05). Conclusions The clinical characteristics of idiopathic and symptomatic occipital lobe epilepsy in children are different. The corresponding treatment plan need to be formulated based on the comprehensive evaluation of clinical seizure forms, head imagings and EEG characteristics.

Key words: idiopathic occipital lobe epilepsy, symptomatic occipital lobe epilepsy, clinical feature, treatment, child

杨雅婷, 蔡玥昊, 方琼, 陈琅, 陈巧彬, 林志, 吴菲菲, 林萌. 儿童特发性和症状性枕叶癫痫临床分析[J]. 临床儿科杂志, 2023, 41(9): 668-673.

YANG Yating, CAI Yuehao, FANG Qiong, CHEN Lang, CHEN Qiaobin, LIN Zhi, WU Feifei, LIN Meng. Clinical analysis of idiopathic and symptomatic occipital lobe epilepsy in children[J]. Journal of Clinical Pediatrics, 2023, 41(9): 668-673.

图/表 3

表1

儿童特发性和症状性枕叶癫痫临床特点比较"

项目	早发型(n=38)	晚发型(n=24)	症状性(n=18)	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	5.5(4.0~7.0)	9.0(7.0~11.8)¹⁾	6.0(4.8~8.0)²⁾	H=22.69	<0.001
女性[n(%)]	13(34.2)	10(41.7)	5(27.8)	χ²=0.89	0.640
临床表现[n(%)]
发热抽搐	11(29.0)	3(12.5)	3(16.7)	χ²=2.73	0.256
单侧阵挛	14(36.8)	6(25.0)	9(50.0)	χ²=2.79	0.247
全身阵挛	23(60.5)	9(37.5)	9(50.0)	χ²=3.14	0.208
眼球偏转	38(100)	9(37.5)	6(33.3)	χ²=36.95	<0.001
头偏转	38(100)	9(37.5)	9(50.0)	χ²=31.79	<0.001
头痛	14(36.8)	12(50.0)	3(16.7)	χ²=4.96	0.084
自主神经症状	34(89.5)	3(12.5)	3(16.7)	χ²=45.18	<0.001
视幻觉	3(7.9)	12(50.0)	3(16.7)	χ²=15.41	<0.001
眼球阵挛	0(0)	6(25.0)	3(16.7)	χ²=13.06	0.001
眼睑扑动	0(0)	12(50.0)	0(0)	-	<0.001³⁾
跌倒	0(0)	12(50.0)	6(33.3)	χ²=29.12	<0.001
视力异常	0(0)	0(0)	12(66.7)	-	<0.001³⁾
神经系统异常体征[n(%)]	0(0)	0(0)	6(33.3)	-	<0.001³⁾
辅助检查[n(%)]
智力低于正常水平	3(7.9)	8(33.3)	15(83.3)	χ²=31.70	<0.001
头颅MRI异常	0(0)	0(0)	18(100)	-	<0.001³⁾
脑电图
背景异常	0(0)	0(0)	15(83.3)	-	<0.001³⁾
左侧枕区放电	15(39.5)	12(50.0)	6(33.3)	χ²=1.27	0.529
右侧枕区放电	15(39.5)	9(37.5)	3(16.7)	χ²=3.06	0.217
双侧枕区放电	9(23.7)	6(25.0)	12(66.7)	χ²=11.27	0.004
放电泛化	12(31.6)	3(12.5)	3(16.7)	χ²=3.60	0.165
闭眼敏感	20(52.6)	16(66.7)	4(22.2)	χ²=8.33	0.016
ESES	13(34.2)	11(45.8)	2(11.1)	χ²=5.75	0.056
睡眠中放电增多	15(39.5)	12(50.0)	9(50.0)	χ²=0.89	0.640
治疗[n(%)]
抗癫痫治疗	27(71.1)	9(37.5)	18(100)	χ²=18.73	<0.001
单药治疗	24(63.2)	6(25.0)	12(66.7)	χ²=10.46	0.005
联合治疗	3(7.9)	3(12.5)	6(33.3)	χ²=5.64	0.060
奥卡西平	9(23.7)	6(25.0)	6(33.3)	χ²=0.60	0.743
丙戊酸钠	6(15.8)	6(25.0)	12(75.0)	χ²=15.46	<0.001
左乙拉西坦	15(39.5)	0(0)	6(33.3)	χ²=18.21	<0.001
托吡酯	0(0)	0(0)	2(11.1)	-	<0.001³⁾

表1

图1

图2

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