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目的研究癫癎诊断和治疗的现状。方法采用回顾性分析方法,对5年间450例门诊和住院的癫癎患儿资料进行发作类型与年龄的关系、脑电图及药物的疗效分析。结果450例中全面性发作63.1%(284例),其中大发作33.3%(150例);局限性发作16.7%(75例);其他类型发作20.2%(91例)。本组68.2%为6岁以下儿童,其中<3岁占73%。1岁以内发作类型最常见为婴儿痉挛(WS),占该年龄组的41.1%(46/112例)。失神发作见于学龄期儿童,占本组病例的2.4%,Lennox-Gastaut综合征在9岁前各年龄组均可发生,热性惊厥转变为大发作见于学龄期儿童。癫癎发作的诱因主要为发热,有家族史占各种诱因的4.7%。癫癎的病程最长13年。脑电图(EEG)异常率达74.9%,其中普通EEG示癎样放电为50.5%,加做video-EEG或24h动态EEG后阳性率达62.8%。65.7%无影像学异常改变。120例(26.7%)诊断后未治疗或服药后未复诊。330例中单药治疗组总疗效76.5%,联合用药组为55.6%,两者之间疗效存在显著差异(P<0.05),而单药治疗组与WS组疗效比较无显著性差异(P>0.05)。结论癫癎治疗以单药治疗为主,但WS联合用药效果较佳。癫癎治疗滥用药现象较严重,有待规范化治疗。
Objective To study the status of diagnosis and treatment of epilepsy. Methods The retrospective analysis method was used to analyze the relationship between seizure type and age, EEG and drug efficacy in 450 outpatients and hospitalized children with epilepsy in 5 years. Results Of the 450 cases, 63.1% (284 cases) were all-encompassing, of which 33.3% were major episodes (150 cases), 16.7% (75 cases) were localized and 20.2% (91 cases) were other episodes. 68.2% of the group were children under 6 years old, of whom <3 years old accounted for 73%. The most common types of seizures within 1 year of age were infantile spasms (WS), accounting for 41.1% (46/112) of this age group. Loss of appetite found in school-age children, accounting for 2.4% of this group of patients, Lennox-Gastaut syndrome in all age groups before 9 years can occur, febrile seizures into major episodes found in school-age children. The main cause of epileptic seizures for fever, family history accounted for 4.7% of various incentives. Epilepsy duration of up to 13 years. The abnormal rate of EEG was 74.9%, of which 50.5% was normal EEG, and 62.8% after video-EEG or 24h dynamic EEG. 65.7% non-imaging abnormalities change. 120 cases (26.7%) did not receive treatment after diagnosis or did not receive referral after taking medicine. The overall efficacy of the single drug treatment group was 76.5% in the 330 cases and 55.6% in the combined treatment group (P <0.05), but there was no significant difference between the single drug treatment group and the WS group (P> 0.05). Conclusion Epilepsy treatment is dominated by monotherapy, but WS combination therapy is better. Epilepsy treatment of drug abuse is more serious, to be standardized treatment.