病毒性脑炎急性期症状性痫性发作演变为脑炎后癫痫临床发生率及影响因素分析
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摘要
目的通过对比分析病毒性脑炎急性期症状性痫性发作演变为脑炎后癫痫临床发生率和影响因素,为治疗脑炎后癫痫提供理论依据。方法选取自2013年1月-2017年1月本院接诊的78例脑炎急性期症状性痫性发作患者为研究对象,对参与研究的患者进行随访,记录患者行为、思维变化等精神状态、影像学检查结果、服用抗癫痫药物情况等指标,采用Logistic回归分析对脑炎急性期症状性痫性发作演变为脑炎后癫痫症状的相关因素进行分析。结果 78例脑炎急性期症状性痫性发作患者中,30例患者在随访过程中发展为脑炎后癫痫患者,发生率为38.46%,其中21例患者在随访6个月内发展为脑炎后癫痫,占发展为脑炎后癫痫患者比率为70%;病毒性脑炎急性期出现癫痫持续症状是影响病毒性脑炎急性期症状性痫性发作发展为脑炎后癫痫的独立危险因素(P <0.05),病毒性脑炎急性期后继续服用抗癫痫药物是影响病毒性脑炎急性期症状性痫性发作发展为脑炎后癫痫的保护性因素(P <0.05)。结论病毒性脑炎急性期症状性痫性发作发展为脑炎后癫痫的临床发生率较高,病毒性脑炎急性期出现癫痫持续症状的患者应继续服用抗癫痫药物。
Objective The incidence of post-encephalitic epilepsy(PEE)and its influencing factors in patients with viral encephalitis at acute symptomatic seizures were compared and analyzed to provide a theoretical basis for the treatment of post-encephalitic epilepsy.Methods 78 patients with acute symptomatic seizures(AESS)were collected from January 2013 to January 2017.The mental state of the patients′behavior and changes of thoughts,imaging findings,taking anti-epileptic drugs and other indicators were collected.With Logistic regression,the factors affected patients with AESS to be PEE were explored.Results 30 developed into PEE among the 78 patients with AESS,with PEE incidence of 38.46%.21 patients developed into PEE within 6months of follow-up,with PEE incidence of 70%;viral encephalitis in the acute phase was an independent risk factor for the development of post-encephalitic epilepsy(P <0.05).The continued use of antiepileptic drugs after the acute phase of viral encephalitis was a protective factor which influence the development of post-encephalitic epilepsy(P <0.05).Conclusion The clinical incidence of post-encephalitic epilepsy in patients with viral encephalitis at acute symptomatic seizures is high,and patients with viral encephalitis at acute symptomatic seizures should continue take antiepileptic drugs after acute encephalitis.
Objective The incidence of post-encephalitic epilepsy(PEE)and its influencing factors in patients with viral encephalitis at acute symptomatic seizures were compared and analyzed to provide a theoretical basis for the treatment of post-encephalitic epilepsy.Methods 78 patients with acute symptomatic seizures(AESS)were collected from January 2013 to January 2017.The mental state of the patients′behavior and changes of thoughts,imaging findings,taking anti-epileptic drugs and other indicators were collected.With Logistic regression,the factors affected patients with AESS to be PEE were explored.Results 30 developed into PEE among the 78 patients with AESS,with PEE incidence of 38.46%.21 patients developed into PEE within 6months of follow-up,with PEE incidence of 70%;viral encephalitis in the acute phase was an independent risk factor for the development of post-encephalitic epilepsy(P <0.05).The continued use of antiepileptic drugs after the acute phase of viral encephalitis was a protective factor which influence the development of post-encephalitic epilepsy(P <0.05).Conclusion The clinical incidence of post-encephalitic epilepsy in patients with viral encephalitis at acute symptomatic seizures is high,and patients with viral encephalitis at acute symptomatic seizures should continue take antiepileptic drugs after acute encephalitis.
引文
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[19]邓波,李翔,陈向军.边缘性脑炎综合征患者中筛查出的自身免疫性脑炎和病毒性脑炎临床特征比较[J].中华神经科杂志,2017,50(6):413-418.
[20]PILLAI SC,MOHAMMAD SS,HACOHEN Y,et al.Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood:Clinical and etiologic risk factors[J].Epilepsia,2016,57(1):7-11.
[21]邹文菁,占建波,王蕾,等.宜昌市2006-2015年急性脑炎及脑膜炎症候群病原谱分析[J].海南医学,2017,28(5):833-835.
[2]黄亮,俞丹,罗蓉,等.儿童病毒性脑炎急性期临床病理特征对继发癫痫的影响[J].四川大学学报:医学版,2017,48(2):257-262.
[3]DIL F,BACCIU A,FALCIONI M,et al.Long-term clinical outcomes of cochlear implantation in children with symptomatic epilepsy[J].Int J Pediatr Otorhi,2016,82(3):23-27.
[4]马海燕,张燕芳,狄晴.病毒性脑炎后癫痫的预后及其影响因素[J].临床神经病学杂志,2016,29(2):120-123.
[5]中华神经科杂志编辑部.中华神经科杂志将与中华医学会第19次全国神经病学学术会议合作出版重点号[J].中华神经科杂志,2016,49(3):86-86.
[6]MA C,LV Y,JIANG R,et al.Novel method for the detection and quantification of malignant cells in the CSF of patients with leptomeningeal metastasis of lung cancer[J].Oncol Lett,2016,11(1):619-623.
[7]JAIN P,SHARMA S,DUA T,et al.Efficacy and safety of anti-epileptic drugs in patients with active convulsive seizures when no IV access is available:Systematic review and meta-analysis[J].Epilepsy Res,2016,122(17):47-55.
[8]李瑾,董利昭,陈一冰,等.急性单纯疱疹病毒性脑炎及脑膜炎患者临床特征及预后分析[J].中国全科医学,2017,20(8):992-996.
[9]王欣,王丽辉,岳玲,等.2014-2015年石家庄地区儿童病毒性脑炎临床流行病学及临床表现[J].脑与神经疾病杂志,2016,24(8):480-484.
[10]朴英善,杜阳,张巍,等.自身免疫性脑炎的临床特点及治疗转归[J].北京医学,2017,39(5):455-459.
[11]黄磊,梁波,李雪莲,等.抗N-甲基-D-天冬氨酸受体脑炎与病毒性脑炎临床及脑脊液细胞学特点比较[J].安徽医科大学学报,2016,51(1):140-142.
[12]THURMAN DJ,LOGROSCINO G,BEGHI E,et al.The burden of premature mortality of epilepsy in high-income countries:A systematic review from the Mortality Task Force of the International League Against Epilepsy[J].Epilepsia,2016,58(1):17-20.
[13]罗龙,杨晓苏.易误诊为病毒性脑炎的成人抗N-甲基-D-天门冬氨酸受体脑炎(附16例临床分析)[J].国际神经病学神经外科学杂志,2017,44(3):289-293.
[14]逯尔慧,赵月梅.病毒性脑膜炎合并症状性癫痫的护理[J].中国药物与临床,2017,17(3):451-452.
[15]吕聪,刘世坤,郭锦辉,等.临床药师参与1例病毒性脑炎伴继发性癫痫患者的药学监护[J].中国药房,2017,28(2):254-257.
[16]LUNSING R J,STRATING K,KONING TJD,et al.Diagnostic value of MRS-quantified brain tissue lactate level in identifying children with mitochondrial disorders[J].Eur Radiol,2016,27(3):1-9.
[17]孙恒斌,余天浩,张宙.连续性血液净化治疗在重症病毒性脑炎伴发癫痫持续状态患者的疗效观察[J].临床神经病学杂志,2016,29(5):363-365.
[18]KOBAYASHI Y,ISHIKAWA N,Tani H,et al.Recurrence of epileptic spasms as reflex seizures induced by eating:a case report and literature review[J].Neuropediatrics,2017,48(2):119-122.
[19]邓波,李翔,陈向军.边缘性脑炎综合征患者中筛查出的自身免疫性脑炎和病毒性脑炎临床特征比较[J].中华神经科杂志,2017,50(6):413-418.
[20]PILLAI SC,MOHAMMAD SS,HACOHEN Y,et al.Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood:Clinical and etiologic risk factors[J].Epilepsia,2016,57(1):7-11.
[21]邹文菁,占建波,王蕾,等.宜昌市2006-2015年急性脑炎及脑膜炎症候群病原谱分析[J].海南医学,2017,28(5):833-835.