Fujita Yukihiko, Imai Yuki, Ishii Wakako, Endo Ayumi, Arakawa Chikako, Kohira Ryutaro, Fuchigami Tatsuo, Okubo Osami, Mugishima Hideo
Division of Medical Education Planning and Development, Nihon University School of Medicine, Itabashi-Ku, Tokyo, Japan.
Brain Dev. 2011 Jan;33(1):62-8. doi: 10.1016/j.braindev.2010.01.002. Epub 2010 Feb 7.
In this study, we report 11 patients with intractable childhood epilepsy that improved following acute viral infection. The patients were 8 boys and 3 girls. Six of the 11 children were diagnosed as West syndrome (5 of the symptomatic type and 1 of the cryptogenic type). The remaining 5 children were myoclonic seizures. The patients became seizure free within 6 days following acute viral infections without an exchange or addition of antiepileptic drugs (AEDs). The types of acute viral infections were Exanthema subitum (Roseola infantum) in 5 patients, Rotavirus gastroenteritis in 2 patients, Measles infection in 2 patients, Herpetic stomatitis in 1 patient and Common cold in the remaining patient. Salaam seizures and/or tonic spasms disappeared within 6 days after the onset of viral infections, and hypsarrhythmia evolved to localized spikes on electroencephalography (EEG) in the patients with West syndrome. Epileptic seizures disappeared rapidly and EEG gradually normalized or improved in patients with myoclonic seizures. Four patients became seizure free for 5 years to 20 years. In 6 patients, seizures relapsed within 14 days to 1 month after the disappearance of seizures. One child remained seizure free for 12 months after viral infection. Common factors in 4 children who were continuously seizure free include (1) normal or almost normal findings of brain CT/MRI, (2) normal development prior to the onset of epileptic seizures, and (3) a short time interval between the onset of seizures and the acute viral infection. We propose several hypotheses including an immunological effect for the improvement of intractable childhood epilepsy following acute viral infection. Further study may provide important information concerning the mechanism of seizure control and the applicable to treatment for intractable childhood epilepsy.
在本研究中，我们报告了11例难治性儿童癫痫患者，他们在急性病毒感染后病情有所改善。患者中8名男孩，3名女孩。11名儿童中有6名被诊断为West综合征（症状性类型5例，隐源性类型1例）。其余5名儿童为肌阵挛性发作。在未更换或添加抗癫痫药物（AEDs）的情况下，患者在急性病毒感染后6天内癫痫发作停止。急性病毒感染的类型为幼儿急疹（婴儿玫瑰疹）5例、轮状病毒胃肠炎2例、麻疹感染2例、疱疹性口炎1例，其余1例为普通感冒。点头痉挛和/或强直性痉挛在病毒感染发病后6天内消失，West综合征患者脑电图（EEG）上的高峰节律紊乱演变为局限性棘波。肌阵挛性发作患者的癫痫发作迅速消失，脑电图逐渐恢复正常或改善。4例患者癫痫发作停止5年至20年。6例患者在癫痫发作消失后14天至1个月内复发。1名儿童在病毒感染后癫痫发作停止12个月。4例持续无癫痫发作儿童的共同因素包括：（1）脑CT/MRI检查结果正常或几乎正常；（2）癫痫发作前发育正常；（3）癫痫发作与急性病毒感染之间的时间间隔较短。我们提出了几种假说，包括急性病毒感染后难治性儿童癫痫病情改善的免疫效应。进一步的研究可能会提供有关癫痫控制机制以及适用于难治性儿童癫痫治疗的重要信息。
