成人非驚厥性癲癇持續狀態患者的臨床及腦電圖特征

張敏+馬煦+楊春曉

[摘要] 目的 探討成人非驚厥性癲癇持續狀態（NCSE）患者的臨床及腦電圖特征，以提高對NCSE的認識，避免漏診及誤診。 方法 對2013年6月～2017年6月哈爾濱醫科大學附屬第一醫院和哈爾濱醫科大學附屬第二醫院共9例確診或高度懷疑為NCSE患者的病因、臨床表現、腦電圖特征及預后進行分析。 結果 9例NCSE患者，急性病因5例，慢性病因2例，未發現特殊病因2例。4例患者發作期通過簡易精神狀態量表（MMSE）檢查，均發現認知功能下降，5例不能配合量表檢查。治療后MMSE量表評估，3例評分較前提高，1例變化不明顯。9例患者腦電圖均見異常，伴明確癲癇樣放電7例，彌漫性慢波背景上節律性delta慢波發放1例，間斷背景解體伴慢波發放有演變1例。5例患者經治療后癥狀緩解，1例治療后仍有發作，1例病情惡化，2例死亡。 結論 NCSE病因、臨床表現及腦電圖均較復雜，提高對NCSE的認識及給予及時的腦電圖檢查是確診的關鍵。預后與病因密切相關，可治性病因導致的NCSE預后較好。

[關鍵詞] 非驚厥性癲癇持續狀態；病因；臨床表現；腦電圖

[中圖分類號] R742.1 [文獻標識碼] A [文章編號] 1673-7210（2018）01（b）-0062-04

[Abstract] Objective To investigate the clinical and EEG features of 9 cases of nonconvulsive status epilepticus （NCSE） with the purpose of increasing cognition of the disease and avoiding missed diagnosis. Methods Nine cases diagnosed or highly suspected of NCSE from the First Affiliated Hospital of Harbin Medical University and the Second Affiliated Hospital of Harbin Medical University from June 2013 to June 2017 were selected， their etiological， clinical manifestations， EEG features and prognosis were analyzed. Results Among 9 NCSE patients， there were 5 cases with acute etiological factors， 2 cases with chronic etiological factors and 2 cases without any special disease. Four patients′cognitive ability was assessed by the mini-mental state examination （MMSE） scale at the stage of attack and cognitive disorder was found， 5 patients can't cooperate with the test. Three patients′ grades were improved after treatment， one was in line with before. All 9 patients presented EEG abnormal with multiple patterns， 7 cases with epileptic discharge， one with slow waves background and rhythmic delta waves discharge， one with EEG background break up accompany slow-wave gave out. Five cases′ seizure remitted after treatment， one case still had a seizure， one with the illness worsened， two cases were dead. Conclusion The etiological， clinical and EEG of NCSE are complex. Increasing cognition of the disease and giving EEG test timely is vital for diagnosis. The prognosis is in line with the etiological， patients with curable etiological factors of NCSE may have an ideal prognosis.

[Key words] Nonconvulsive status epilepticus； Etiological factors； Clinical manifestations； EEG

癲癇持續狀態（status epilepticus，SE）是神經科較常見的危急重癥之一，2015年國際抗癲癇聯盟（international league against epilepsy，ILAE）按SE癥狀學進行分類，分為具有顯著運動癥狀的SE（convulsive status epilepticus，CSE）和不伴顯著運動癥狀的SE（nonconvulsive status epilepticus，NCSE）[1]。NCSE病因復雜，臨床表現常不典型，容易被漏診及誤診。近年來，由于腦電圖（EEG）監測技術的發展，使越來越多的NCSE患者能夠得到有效的診斷與治療。為提高對本病的認識，現對9例確診或高度懷疑為NCSE患者的病因、臨床表現、EEG特征進行總結。endprint