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目的观察婴儿痉挛(IS)患儿促皮质素(ACTH)治疗前后视频脑电图(VEEG)变化并进行追踪随访,以了解其与预后的关系并评价影响预后的因素。方法对2008年1月-2011年1月在本科住院的52例IS患儿行VEEG长时间监测,对治疗前后VEEG进行分析,包括高峰失律、背景、睡眠纺锤波等;并对其临床随访资料进行回顾性研究。结果 ACTH患儿治疗4周后无论症状性IS还是隐源性IS,高峰失律均基本消失。随访6个月,无发作16例;发作未完全缓解36例,发作形式为痉挛发作、局限性发作和全面强直发作。病程≤2个月、隐源性IS、起病年龄<8个月、ACTH近期疗效好及VEEG为典型高峰失律的患儿临床预后好;ACTH治疗前VEEG呈局灶性高峰失律者预后不良;ACTH满疗程时VEEG背景不正常、高峰失律不消失及睡眠纺锤波持续不出现者临床预后不良;随访6个月VEEG仍为高峰失律的患儿均为症状性IS,预后差。结论 ACTH治疗前后监测VEEG对评价IS临床预后具有重要作用。
Objective To observe the changes of VEEG in children with infantile spasticity (IS) before and after corticosteroid (ACTH) treatment and follow-up to understand its relationship with the prognosis and evaluate the prognostic factors. Methods 52 cases of IS children hospitalized in our department from January 2008 to January 2011 were monitored for VEEG for a long time. VEEG before and after treatment were analyzed, including peak loss, background, sleep spindles, etc; and their clinical follow-up Data for retrospective study. Results After 4 weeks of treatment, ACTH children basically disappeared regardless of symptom IS or cryptogenic IS. Follow-up 6 months, no seizures in 16 cases; seizures did not completely relieve 36 cases, seizures in the form of spasms, seizures and generalized tonic seizures. The course of disease is less than 2 months, cryptogenic IS, onset age <8 months, good short-term efficacy of ACTH and VEEG is a typical peak in children with good clinical prognosis; ACTH before treatment was focal peak VEEG prognosis Bad; VEEG full course of ACTH when the background is not normal, the peak loss of law does not disappear and sleep spindles continued to appear poor clinical prognosis; follow-up 6 months VEEG is still the peak of the law of symptoms of children with poor prognosis, poor prognosis. Conclusion The monitoring of VEEG before and after ACTH treatment plays an important role in the evaluation of clinical prognosis of IS.