Tanabe Takuya, Hara Keita, Kashiwagi Mitsuru, Tamai Hiroshi
Division of Pediatrics, Hirakata City Hospital, 2-14-1 Kinyahonmachi, Hirakata City, Osaka 573-1013, Japan.
Epilepsy Res. 2006 Aug;70 Suppl 1:S185-9. doi: 10.1016/j.eplepsyres.2006.02.007. Epub 2006 Jun 30.
The aim of this study is to classify infantile cases with benign seizures into known epileptic syndromes, thereby facilitating discussion of clinical factors that could play an important role in diagnosis.
Fifty-seven patients with afebrile seizures fulfilling all of the following criteria were enrolled: (1) normal development prior to the onset, (2) no underlying disorders nor neurological abnormalities, (3) onset before the age of four and (4) normal interictal EEG and neuroimaging findings.
Thirty-nine cases (Group A) were characterized by an association of mild gastroenteritis. The remaining 18 cases were divided into two groups according to the seizure type. One group had partial seizures (Group B, 13 cases) while the other was suspected to have generalized seizures (Group C, 5 cases). Age at onset was significantly higher for Group A (19.5 +/- 5.5 months) than Groups B (5.3 +/- 1.8 months) (p<0.001) and C (5.8 +/- 3.5 months) (p=0.038). Positive family history of seizure disorder, seizure cluster tendency, and the efficacy of lidocaine against seizure clusters were common in the three groups.
Features in Group A were consistent with benign convulsions with mild gastroenteritis (proposed by Morooka) [Morooka, K., 1982. Mild diarrhea and convulsions. Shonika 23, 134-137 (in Japanese)], those of Group B with benign partial epilepsy in infancy [Watanabe, K., Yamamoto, N., Negoro, T., Takaesu, E., Aso, K., Furune, S., Takahashi, I., 1987. Benign complex partial epilepsies in infancy. Pediatr. Neurol. 3, 208-211], and those of Group C with benign infantile convulsions [Fukuyama, Y., 1963. Borderland of epilepsy with special reference to febrile convulsions and so-called infantile convulsions. Seishin Igaku 5, 211-223 (in Japanese)]. The distinction between these syndromes depends upon age at onset, association with gastroenteritis, and ictal symptomatology. In our experience, however, it was not easy to catch seizure type accurately in clinical situations. As far as the results of ictal video-EEG monitoring ever carried out concern, focal initiation of parxysmal discharges was demonstrated in all cases, not only of BPEI but also of apparent generalized seizures examined without exception. These observations led the authors to conclude that the identity of BIC is dubious, most probably it will represent a subtype of BPEI.
本研究旨在将婴儿良性惊厥病例归类到已知的癫痫综合征中，从而便于讨论在诊断中可能起重要作用的临床因素。
纳入了57例符合以下所有标准的无热惊厥患者：（1）发病前发育正常；（2）无潜在疾病及神经学异常；（3）4岁前发病；（4）发作间期脑电图和神经影像学检查结果正常。
39例（A组）的特征为伴有轻度胃肠炎。其余18例根据惊厥类型分为两组。一组为部分性发作（B组，13例），另一组疑似全身性发作（C组，5例）。A组的发病年龄（19.5±5.5个月）显著高于B组（5.3±1.8个月）（p<0.001）和C组（5.8±3.5个月）（p=0.038）。三组中癫痫发作障碍的阳性家族史、惊厥丛集倾向以及利多卡因对惊厥丛集的疗效较为常见。
A组的特征与轻度胃肠炎伴良性惊厥（由Morooka提出）[Morooka, K., 1982. 轻度腹泻与惊厥。小儿科23, 134 - 137（日文）]相符，B组与婴儿期良性部分性癫痫[Watanabe, K., Yamamoto, N., Negoro, T., Takaesu, E., Aso, K., Furune, S., Takahashi, I., 1987. 婴儿期良性复杂部分性癫痫。儿科神经病学3, 208 - 211]相符，C组与良性婴儿惊厥[Fukuyama, Y., 1963. 癫痫的边缘情况，特别提及热性惊厥和所谓的婴儿惊厥。精神医学5, 211 - 223（日文）]相符。这些综合征之间的区别取决于发病年龄、与胃肠炎的关联以及发作期症状学。然而，根据我们的经验，在临床情况下准确捕捉惊厥类型并不容易。就曾经进行的发作期视频脑电图监测结果而言，所有病例均显示发作性放电的局灶起始，不仅在婴儿期良性部分性癫痫中如此，在所有检查的明显全身性发作中也无一例外。这些观察结果使作者得出结论，良性婴儿惊厥的身份值得怀疑，很可能它将代表婴儿期良性部分性癫痫的一个亚型。
