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目的探讨小儿夜间发作额叶癫的正电子发射扫描(PET)与视频脑电图(VEEG)的特征及治疗后VEEG改变。方法收集2005年6月-2008年6月本院儿科确诊的夜间发作额叶癫患儿37例(实验组),其他类型的夜间发作的癫患儿60例(对照组)。记录二组患儿性别、发病年龄、发作频率、癫家族史。实验组予卡马西平或奥卡西平治疗,有过敏者予丙戊酸钠或托吡酯治疗。均行头颅PET检查,治疗前、治疗3个月行VEEG检查,实验组30例及对照组所有患儿行头颅MRI检查。结果实验组患儿PET存在额叶异常者24例(64.9%);实验组17例患儿PET为单侧异常,其中16例患儿VEEG性放电为单侧。实验组和对照组患儿PET与VEEG完全一致、部分一致、完全不一致的差异无统计学意义(P>0.05)。19例PET正常或轻度异常患儿,VEEG清醒期有性放电8例,睡眠期放电8例,清醒和睡眠均放电3例;7例PET重度异常患儿,清醒期及睡眠期均有性放电6例,PET结果与VEEG性放电时期呈正相关(r=0.461P<0.05)。治疗后原7例PET正常患儿中5例VEEG为轻度异常;而7例PET重度异常患儿4例VEEG中度异常,3例重度异常,其PET结果与治疗后VEEG的异常程度呈正相关(r=0.410P<0.05)。结论夜间发作额叶癫患儿存在额叶异常,其PET检查结果与患儿的VEEG性放电的时间和部位相符、相关,PET重度异常的患儿治疗后VEEG仍较差。
Objective To investigate the characteristics of positron emission tomography (PET) and video electroencephalography (VEEG) in pediatric nocturnal frontal epilepsy and the changes of VEEG after treatment. Methods Thirty-seven patients (experimental group) with nocturnal frontal lobe epilepsy diagnosed in our hospital from June 2005 to June 2008 were collected, and 60 other types of epileptic infants with nocturnal onset (control group) were collected. Record two groups of children with gender, age of onset, seizure frequency, family history of epilepsy. Experimental group to carbamazepine or oxcarbazepine treatment, allergic to sodium valproate or topiramate treatment. All patients underwent head PET examination. Before treatment, VEEG examination was performed 3 months after treatment. All patients in experimental group and control group underwent MRI examination. Results In the experimental group, 24 cases (64.9%) had frontal lobe abnormalities in PET, and 17 cases in experimental group were unilateral abnormalities. Among them, 16 cases had unilateral VEEG discharge. PET and VEEG in experimental group and control group were completely consistent, partially consistent and completely inconsistent with no significant difference (P> 0.05). In 19 cases of PET with normal or mild abnormalities, there were 8 cases of purulent discharge in the VEEG awake stage, 8 cases of discharge in sleep stage, 3 cases of awake and sleep discharge, 7 cases of severe PET dyspepsia in awake and sleep stage Six cases of 放 discharge, PET results and VEEG period of discharge was positively correlated (r = 0.461P <0.05). Five of the seven normal PET children after treatment had mild abnormalities of VEEG. Seven of seven patients with severe PET abnormality were moderately abnormal in VEEG and three had severe abnormalities. The PET results were positively correlated with the degree of VEEG abnormalities after treatment (r = 0.410P <0.05). Conclusions Frontal lobe epilepsy occurs in frontal nocturnal patients with abnormal frontal lobe. The results of PET examination are consistent with the time and location of VEEG discharge in children. Correlation, VEEG is still poor in children with severe PET.