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目的对比分析早发性儿童良性枕叶癫痫(EBOS)和晚发性儿童良性枕叶癫痫(LOS)的临床特点、EEG改变、治疗及预后,帮助临床诊治。方法30例患者,经临床和EEG诊断为枕部放电的儿童良性癫痫(BCEOP),再按2001年国际抗癫痫联盟建议,区分为EBOS组12例和LOS组18例,对比分析两组发病年龄、既往史、家族史、发作频率、持续时间及时间分布、临床特征、EEG改变及对药物治疗的反应。结果EBOS组平均发病年龄(5.6±2.4)岁,发作频率少而持续时间长,有夜间发作倾向;LOS组平均发病年龄(12.1±2.7)岁,发作频率高而持续时间短,视觉症状常见,可出现视幻觉,易继发全身强直-阵挛发作,白天发作为主。两组患者头眼偏转发作、跌倒发作及发作后头痛、呕吐症状无显著性差异(P>0.05)。两组发作间期EEG大部分示枕叶为主的棘、尖慢波,但EBOS组较局限且波形典型;LOS组易于泛化。EBOS对多种抗癫痫药物(AED)反应好,单药治疗均可控制发作;LOS对AED治疗反应差,5例(27.8%)无效。结论EBOS和LOS在发病年龄、发作频率及持续时间、发作时间分布、视觉症状、EEG放电特点、对AED治疗的反应等方面均有差别,综合分析上述特征可从临床上作鉴别诊断。
Objective To compare and analyze the clinical features of benign occipital epilepsy (EBOS) and benign occipital lobe epilepsy (LOS) in children with early onset, the changes, treatment and prognosis of EEG, and to help clinical diagnosis and treatment. Methods Thirty patients with benign epilepsy (BCEOP) diagnosed as occipital discharge by clinic and EEG were divided into 12 cases of EBOS group and 18 cases of LOS group according to the 2001 International Antiepileptic Association recommendation. The age of onset was compared between the two groups , Past history, family history, frequency of seizures, duration and time distribution, clinical features, changes in EEG, and response to medication. Results The mean age at onset of EBOS was (5.6 ± 2.4) years old with less seizure frequency and longer duration of seizures. The mean age of onset was (12.1 ± 2.7) years in LOS group. The seizure frequency was high and the duration was short. Visual symptoms were common, There may be visual hallucinations, easy to secondary systemic tonic - clonic seizures, attack during the day as the main. There was no significant difference in headache and vomiting between the two groups (P> 0.05). Most of the EEG between the two groups showed occipital lobe-based spines and sharp waves, but the EBOS group was more limited and the typical waveform; LOS group generalized. EBOS responded well to various anti-epileptic drugs (AEDs), and monotherapy failed to control seizures; LOS responded poorly to AEDs and was ineffective in 5 patients (27.8%). Conclusions EBOS and LOS are different in age of onset, frequency and duration of seizure, distribution of seizure time, visual symptoms, EEG discharge characteristics and response to AED treatment. The above characteristics can be differentially diagnosed clinically.