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癫痫伴发Brugada样心电图改变17例临床特点分析

Clinical characteristics of Brugada-like electrocardiogram patter in 17 epileptic patients

摘要:

目的 探讨癫痫发作后表现为Brugada样心电图(Brugada-like electrocardiogram,Bru-ECG)患者的临床特点及转归.方法 选择2002年5月至2013年11月在宁波市第七医院及宁波市精神卫生中心的2 018例癫痫患者,将17例(0.84%)癫痫发作后可出现Bru-ECG患者作为病例组(1组),随机双盲选取17例癫痫发作无Bru-ECG患者为对照组(2组),比较两组一般资料、心电图、脑电图、血清钾浓度及药物,进行长期随访,并采集接受钠离子通道阻滞药物诱发试验(sodium-channel blocker test,SCBT)及SCN5A基因检测患者数据.结果 1组患者Ⅰ型及Ⅱ型Bru-ECG分别为14例(82.35%)及3例(17.65%),l组男性、年龄、右侧颞叶起源癫痫、癫痫持续时间及心室率波动多于2组(P<0.05),两组间病程、癫痫发作类型、脑电图异常程度、QT间期、血清钾浓度、长期服用相关药物差异无统计学意义(P>0.05),15例(88.24%)患者Bru-ECG在(11.71±9.62)h消失.随访(3.85±1.74)年,3例(17.65%)患者癫痫再发后心电图重现Bru-ECG且可消失,去除药物干预后仍有3例(17.65%)维持Bru-ECG.15例(88.24%)进行药物诱发试验患者中2例(6.67%)结果呈阳性,所有患者经SCN5A基因编码区检测,2例(11.76%)维持Ⅰ型Bru-ECG患者SCN5A基因突变,其中1例(5.88%) SCBT阳性、维持Ⅰ型Bru-ECG且SCN5A基因变异的男性患者记录到恶性室性心律失常.结论 癫痫发作后心电图出现Bru-ECG患者以Ⅰ型、男性、右侧颞叶起源多见,有年龄较大、心室率较快及癫痫持续时间较长的特点,发生率较低,多数呈反复及一过性,具有较好的临床预后,对于符合Brugada综合征患者,需进行积极治疗.

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abstracts:

Objective To evaluate the clinical characteristics and prognosis of epileptic patients(EP)with Brugada-like electrocardiogram(Bru-ECG) patter.Methods Tow thousand and eighteen EP were enrolled from May 2002 to November 2013.A randomized,double-blind study was performed.17 EP with Bru-ECG patter (group 1) were randomly compared with those in control group(17 patients without Bru-ECG patter,group 2) after seizure disorder.Characteristics of baseline,ECG,electroencephalogram (EEG),serum potassium concentration(SPC),drugs were compared between two groups.All EP were long-term follow-up and sodium-channel blocker test(SCBT)was performed and SCN5A mutations were collected.Results There were 14(82.35%)and 3(17.65%)EP with type 1 and 2 Bru-ECG patter,respectively.EP with more prevalence of males and right temporal lobe epilepsy,elder,longer durations and more fluctuation of mean ventricular rates were more likely to be with Bru-ECG patter (P>0.05).There were no significant differences in course,type of epilepsy,disorder degree of EEG,QT interval,fluctuation of SPC,and related drugs token between two groups(P>O.05).Bru-ECG patter disappeared in 15 (88.24%) EP in (11.71 ± 9.62) hours.With a mean follow-up of (3.85 ± 1.74) years,3(17.65%) EP transiently reappeared Bru-ECG patter,3 (17.65%)patients remained with Bru-ECG patter even without drug intervention,2 in 15 patients(6.67%) got a positive SCBT,2(11.76%) EP had an SCN5A mutation remained with type Ⅰ Bru-ECG patter.One male patient suffered from malignant arrhythmias featured with positive SCBT,sustained type Ⅰ Bru-ECG and SCNSA mutation.Conclusion EP with Bru-ECG patter characterized by more common in male,right temporal lobe located and type Ⅰ,elder,higher ventricular rate,and more durations of seizure disorder compared with those without Bru-ECG patter.Most of EP with Bru-ECG patter are transient,less experience of recurrent attacks,and have a relative satisfied prognosis and a low incidence,whereas to those considered as BrS,more attention should be paid for further treatment.

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