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目的通过分析重症病毒性脑炎患儿非惊厥性癫持续状态(NCSE)的临床特征、诊断和治疗,提高对NCSE的认识。方法回顾性分析2012年6月至2014年9月广州市妇女儿童医疗中心神经内科诊断为重症病毒性脑炎NCSE的病例。结果 19例重症病毒性脑炎NCSE连续病例进入本文分析,男5例。脑炎起病年龄(7.2±3.9)岁;Glasgow评分(8.6±1.9)分;脑炎起始与NCSE起始间隔4~70(19.4±20.9)d;昏迷中癫持续状态(SEC)4例,复杂部分发作持续状态4例,不典型失神发作持续状态1例。2病因包括病毒性脑炎8例,病毒性脑炎抗癫药物调整1例;9例前驱均有惊厥,其中3例伴惊厥性癫持续状态。39例临床发现主要有口面部或肢体微小抽动、认知障碍、孤独症样行为等。4VEEG发作期主要以背景活动变慢,伴δ、θ、β、棘节律,或棘慢波持续发放为特征。54例SEC患儿予麻醉药联合多种抗癫药物治疗,发作平均持续42.8 d;5例非SEC患儿予多种抗癫药物治疗,其中3例发作平均持续9 d,1例抗癫药物调整所致NSEC发作持续4个月。61例自动出院失访,1例死亡,余7例随访3个月至2.5年;6例VEEG均有不同程度的发作期或发作间期脑电异常,1例正常;1例神经学功能正常,5例有不同程度认知下降伴继发性癫,1例持续植物状态伴继发性癫。结论口面部或肢体运动现象、认知及行为改变为重症病毒性脑炎患儿NCSE临床特征;发作期脑电波形变异大,棘节律可能是重症病毒性脑炎患儿NCSE的独特形式;抗癫治疗及起效时间与NCSE类型相关。
Objective To improve the understanding of NCSE by analyzing the clinical features, diagnosis and treatment of non-convulsive epileptic seizures (NCSE) in children with severe viral encephalitis. Methods A retrospective analysis of cases diagnosed as severe viral encephalitis NCSE from Department of Neurology, Guangzhou Women and Children Medical Center from June 2012 to September 2014 was conducted. Results 19 cases of severe viral encephalitis NCSE consecutive cases into this analysis, 5 males. The onset age of encephalitis was (7.2 ± 3.9) years; the Glasgow score was (8.6 ± 1.9) points; the interval between the start of encephalitis and NCSE was 4 ~ 70 (19.4 ± 20.9) d; the coma was epilepticus (SEC) , Complicated part of the attack in 4 cases, atypical absence of attack in 1 case. 2 etiologies include viral encephalitis in 8 cases, viral encephalitis antiepileptic drugs in 1 case; 9 cases had convulsions in the precursor, 3 cases with convulsive status epilepticus. 39 cases of clinical findings mainly oral or limb twitch, cognitive disorders, autism-like behavior. 4VEEG attack mainly slows the background activity, with δ, θ, β, spine rhythm, or sustained spike slow wave characterized. 54 cases of children with SEC were given anesthesia combined with antiepileptic drugs for a mean duration of 42.8 days. Five non-SEC children were given antiepileptic drugs, of which 3 cases sustained an average of 9 days and 1 case of antiepileptic drugs Adjust the resulting NSEC attack for 4 months. Sixty-one patients were discharged from hospital voluntarily, one died, and the remaining seven patients were followed up for 3 months to 2.5 years. There were 6 cases of VEEG with different degree of attack or interictal EEG, 1 case of normal, 1 case of normal neurological function , 5 cases had different degrees of cognitive decline with secondary epilepsy, 1 case of persistent vegetative state with secondary epilepsy. Conclusions Oral or limb movement, cognitive and behavioral changes are the clinical features of NCSE in children with severe viral encephalitis. The encephalic wave amplitude in the attack stage is large, and the spinous process may be the unique form of NCSE in children with severe viral encephalitis. Epilepsy treatment and onset time associated with NCSE type.