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目的探讨脑性瘫痪患儿伴发癫癎的临床特点及其相关危险因素。方法对2004-01—2005-12期间青岛市残疾儿童医疗康复中心治疗的185例脑瘫患儿进行详细的病史采集、脑电图以及影像学检查、认知功能评定,分析不同类型脑瘫患儿癫癎的伴发率、发作类型、发病年龄等临床特征,采用Logistic逐步回归分析验证性别、出生体重、新生儿期惊厥史、围生期高危因素、认知水平、影像学改变等因素对合并癫癎的影响效应。结果25.9%(48/185例)脑瘫患儿伴发了癫癎,脑瘫类型包括痉挛型四肢瘫、偏瘫、双瘫、混合型、失调型和不随意运动型。这6型脑瘫患儿癫癎伴发率依次为58.97%、31.58%、16.07%、20.69%、12.5%和7.14%;伴发癫癎的患儿中29例(60.42%)在1岁内发病,而痉挛偏瘫和失调型脑瘫伴发癫癎发病都在1岁之后。Logistic回归分析发现产时高危因素、新生儿期惊厥史、IQ/DQ低下、影像学显示皮质受损均是伴发癫癎的危险因素,早产、新生儿疾病、孕期因素与伴发癫癎无明显关系,而单纯脑白质损伤是脑瘫伴发癫癎的保护性因子。结论癫癎是脑瘫患儿的常见并发症,尤其见于四肢瘫和偏瘫,往往较早发病,以婴儿痉挛和部分性发作为主要类型。新生儿期惊厥史、IQ/DQ低下、皮质受损对脑瘫患儿伴发癫癎有预示价值。
Objective To investigate the clinical features and related risk factors of epilepsy in children with cerebral palsy. Methods A total of 185 children with cerebral palsy who were treated at Qingdao Medical Center for the Rehabilitation of Disabled Children during 2004-01-2005-12 were collected for detailed history collection, EEG, imaging examination and cognitive function assessment.癎 complication rate, type of attack, age of onset and other clinical features, using Logistic regression analysis to verify gender, birth weight, neonatal seizures history, perinatal risk factors, cognitive level, imaging changes and other factors on the combined epilepsy影 influence effect. Results 25.9% (48/185) children with cerebral palsy had epilepsy. The types of cerebral palsy included spastic quadriplegia, hemiparesis, double paraplegia, mixed type, dysregulation and involuntary exercise. The incidences of epilepsy in children with type 6 cerebral palsy were 58.97%, 31.58%, 16.07%, 20.69%, 12.5% and 7.14%, respectively. Among the children with epilepsy, 29 (60.42% , And spastic hemiplegia and dyslipidemia with epilepsy cerebral palsy are in 1 year old. Logistic regression analysis found that high risk factors during labor, neonatal convulsions, low IQ / DQ, imaging showed that cortical injury were risk factors associated with epilepsy, premature birth, neonatal disease, pregnancy and concomitant epilepsy Obvious relationship, and simple white matter damage is cerebral palsy associated with epilepsy protective factor. Conclusion Epilepsy is a common complication of children with cerebral palsy, especially in quadriplegia and hemiplegia, often with earlier onset, with infantile spasms and partial seizures as the main type. Neonatal convulsions history, IQ / DQ low, cortical damage in children with cerebral palsy associated with epilepsy has predictive value.