摘要目的 根据首次丙戊酸治疗儿童失神癫痫(CAE)0.5年后疗效,评估抗癫痫药物治疗CAE反应和短期预后,探讨CAE首次治疗失败的危险因素.方法 从2010年1月至2015年12月在南京医科大学附属儿童医院行视频脑电图(VEEG)检查的患儿中检索“典型失神”病例,根据1989年国际抗癫痫联盟提出的CAE诊断标准,筛选出67例符合CAE的病例,以0.5年治疗效果为界将其分组:观察0.5年后仍有典型失神发作者为发作未控制组,0.5年内发作消失者为发作控制组.分析统计各组病例的临床和VEEG特征,采用多因素Logistic回归分析性别、起病年龄、家族史、符合2005年Panayiotopoulos诊断标准及VEEG特征与CAE治疗效果的关系.结果 起病年龄(5.89±2.91)岁,随访0.5年,发作未控制23例(34.3％),患儿性别、起病年龄、是否出现全面性强直阵挛发作、热性惊厥家族史、癫痫家族史均与CAE的治疗效果无关(均P＞0.05).与发作控制组比较,发作未控制组VEEG特征中间期出现睡眠中局灶性痫样放电(87.0％比6.8％)、间断闪光刺激(IPS)(52.2％比6.8％)诱发失神发作率明显增多(均P＜0.05);而清醒期枕区节律性δ活动(OIRDA)(8.7％比77.3％)及符合2005年Panayiotopoulos诊断标准(8.7％比88.6％)病例数明显减少(均P＜0.001).多因素Logistic回归分析发现,间期睡眠中局灶性痫样放电和清醒期OIRDA与预后有明显相关性(OR=133.714,P＜0.05;OR=0.068,P＜0.05).结论 VEEG特征中间期出现局灶性痫样放电、IPS诱发典型失神发作预示着CAE首次药物治疗可能会失败,而OIRDA反之;临床特征和治疗预后无明显相关性.

abstractsObjective To observe the initial therapy outcomes of Valproic acid for childhood absence epilepsy (CAE),and to assess its therapeutic reaction and short-term prognosis,and to investigate the risk factors for initial therapy failure.Methods From January 2010 to December 2015,absence seizures as key words were used to search CAE in the video-electroencephalogram(VEEG) database of Children's Hospital Affiliated to Nanjing Medical University.Sixty-seven children fulfilled the CAE diagnosis criteria of International League Against Epilepsy in 1989.These patients were separated into 2 groups based on the therapy outcome after 6 months,including seizure control failure group and seizure control group.The patients' clinical characteristics and VEEG characteristics were reviewed.The gender,age of seizure onset,a family history of epilepsy or febrile seizures (FS),consistent with 2005 Panayiotopoulos diagnostic criteria,and VEEG findings were analyzed to evaluate the predictive ability of independent variables and the relationship between these features and treatment outcomes by using a stepwise multivariate Logistic regression model.Results The age at seizure onset was (5.89 ± 2.91) years old,and follow up duration was 6 months.Approximately 23 cases (34.3％) of CAE patients had poor response.No statistical correlation was made for gender,age at onset,the occurrence of generalized tonic clonic seizures,and family history of FS or epilepsy between 2 groups (all P ＞0.05).Compared with seizure control group,patients of the seizure control failure group had significantly higher rates of focal epileptic discharge (87.0％ vs.6.8％),higher rates of intermittent photic stimulation (IPS) induced seizures (52.2％ vs.6.8 ％),fewer rates of occipital intermittent delta activity (8.7 ％ vs.77.3 ％),and fewer rates of patients met the new diagnostic criteria proposed by Panayiotopoulos in 2005 (8.7％ vs.88.6％) (all P ＜ 0.001).The presence of occipital intermittent rhythmic delta activity during wake stage and the interictal focal epileptiform discharges on VEEG during sleep stage were significantly associated with the therapy outcomes in a multivariable Logistic regression analysis (OR =133.714,P ＜ 0.05;OR =0.068,P ＜ 0.05).Conclusions The presence of focal epileptiform discharges,and a typical absence induced by IPS are important factors for first-drug treatment failures with CAE,and conversely the occipital intermittent rhythmic delta activities have a good efficacy.There is no statistical correlation between clinical characteristics and treatment outcomes.