CAJ | 학술논문

目的：探讨睡眠中癫痫性电持续状态（electrical status epilepticus during sleep，ESES）的脑电诊断及临床治疗。方法脑电图棘慢波指数（SWI）≥50％并完成治疗的癫痫患儿30例（A 组16例：50％≤SWI＜85％；B 组14例：SWI≥85％），按就诊顺序随机分为 C、D 2组，每组15例，行不同疗程（C 组6个月，D 组12个月）激素治疗，治疗前后均进行神经心理损伤评估，并随访治疗后的疗效及不良反应。结果A、B 2组治疗前均有程度不一的神经心理损伤，言语智商（VIQ）、操作智商（PIQ）及总智商（FIQ）均较正常值低，以 VIQ 下降最显著，B 组 VIQ 和 FIQ较 A 组低，差异有统计学意义（P ＜0．05）；C、D 组 VIQ、FIQ 较激素治疗前均有增高（P ＜0．05），其中 ESES 消失者VIQ、FIQ 明显高于治疗前（P ＜0．05），但 C、D 2组间神经心理损伤改善程度及总有效率比较差异无统计学意义（P ＞0．05）；D 组不良反应大于 C 组（P ＜0．05）。结论SWI≥50％定为 ESES 的脑电诊断标准有助于 ESES 的合理诊断，早期干预；激素治疗 ESES 安全有效，疗程6个月更合理。
목적：탐토수면중전간성전지속상태（electrical status epilepticus during sleep，ESES）적뇌전진단급림상치료。방법뇌전도극만파지수（SWI）≥50％병완성치료적전간환인30례（A 조16례：50％≤SWI＜85％；B 조14례：SWI≥85％），안취진순서수궤분위 C、D 2조，매조15례，행불동료정（C 조6개월，D 조12개월）격소치료，치료전후균진행신경심리손상평고，병수방치료후적료효급불량반응。결과A、B 2조치료전균유정도불일적신경심리손상，언어지상（VIQ）、조작지상（PIQ）급총지상（FIQ）균교정상치저，이 VIQ 하강최현저，B 조 VIQ 화 FIQ교 A 조저，차이유통계학의의（P ＜0．05）；C、D 조 VIQ、FIQ 교격소치료전균유증고（P ＜0．05），기중 ESES 소실자VIQ、FIQ 명현고우치료전（P ＜0．05），단 C、D 2조간신경심리손상개선정도급총유효솔비교차이무통계학의의（P ＞0．05）；D 조불량반응대우 C 조（P ＜0．05）。결론SWI≥50％정위 ESES 적뇌전진단표준유조우 ESES 적합리진단，조기간예；격소치료 ESES 안전유효，료정6개월경합리。
ABSTRACT:Objective To investigate the EEG diagnosis and clinical treatment of electrical sta-tus epilepticus during sleep(ESES).Methods According to the spike-wave index(SWI),30 chil-dren with epilepsy were divided into group A(50% ≤ SWI< 85%,n= 16)and group B(SWI≥85%,n=14).According to the visiting sequence,these children were divided into group C(hor-mone treatment for 6 months,n= 15)and group D(hormone treatment for 12 months,n= 15). Neuropsychological impairment was assessed before and after treatment.In addition,the efficacy and adverse reactions were observed after treatment.Results Both group A and group B had dif-ferent degrees of neuropsychological impairment and lower verbal intelligence quotient(VIQ), performance intelligence quotient(PIQ)and full intelligence quotient(FIQ)before treatment.A-mong these indicators,VIQ decreased most significantly.Compared with group A,both VIQ and FIQ significantly decreased in group B(P <0.05).In both group C and group D,VIQ and FIQ in-creased after hormone treatment,especially in children with the disappearance of ESES (P <0.05).Compared with group C,adverse reactions significantly increased in group D(P <0.05). However,no significant differences in the improvement in neuropsychological impairment and o-verall response rate between the two groups(P >0.05).Conclusion The criterion of SWI≥50%contributes to the reasonable diagnosis and early intervention of ESES.Hormone treatment for 6 months is effective and reasonable for ESES.