Cooper Monica S, Mackay Mark T, Fahey Michael, Reddihough Dinah, Reid Susan M, Williams Katrina, Harvey A Simon
The Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Victoria, Australia.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-2975. Epub 2017 Feb 16.
The goal of this study was to describe the prevalence, syndromes, and evolution of seizure disorders in children with cerebral palsy (CP) due to white matter injury (WMI).
For this population-based cohort study, brain MRI scans and medical records were reviewed in children in the Victorian Cerebral Palsy Register born between 1999 and 2006 recorded as having WMI. Children were excluded if they had features of an undiagnosed syndrome, associated cortical malformation or injury, or no medical contact in the preceding year. Included were 166 children with CP and isolated WMI due to presumed vascular insufficiency or hemorrhage; 87 were born preterm. Seizure and CP details were obtained from medical records and interviews, and EEG recordings were reviewed.
Forty-one children (25%) had seizures beyond the neonatal period. Four children had West syndrome, which resolved with treatment. Thirteen children had febrile seizures that they outgrew. Thirty children had focal epilepsy with seizure manifestations and EEG discharges typical of early-onset childhood occipital epilepsy or childhood epilepsy with centrotemporal spikes; 23 have outgrown these seizures. Two children had idiopathic generalized epilepsy; it was ongoing in 1 child. Fourteen children had evolution from 1 epileptic syndrome to another. At last follow-up (median age, 12.7 years; minimum age, 9.7 years), 80% had not had a seizure for >2 years.
The electroclinical features of seizure disorders associated with CP and WMI are those of the age-limited, epileptic syndromes of childhood, with favorable outcome in the majority. The findings have important implications for counseling and drug treatment.
本研究的目的是描述因白质损伤（WMI）导致的脑瘫（CP）患儿癫痫发作疾病的患病率、综合征及演变情况。
在这项基于人群的队列研究中，对1999年至2006年出生并记录为患有WMI的维多利亚脑瘫登记册中的儿童进行了脑部MRI扫描和病历审查。如果儿童具有未确诊综合征、相关皮质畸形或损伤的特征，或者在前一年没有医疗接触，则将其排除。纳入的166名儿童患有因假定血管功能不全或出血导致的CP和孤立性WMI；87名儿童为早产儿。从病历和访谈中获取癫痫发作和CP的详细信息，并审查脑电图记录。
41名儿童（25%）在新生儿期后出现癫痫发作。4名儿童患有韦斯特综合征，经治疗后缓解。13名儿童患有热性惊厥，长大后自愈。30名儿童患有局灶性癫痫，其癫痫发作表现和脑电图放电具有早发性儿童枕叶癫痫或伴有中央颞部棘波的儿童癫痫的典型特征；23名儿童的这些癫痫发作已不再发作。2名儿童患有特发性全身性癫痫；其中1名儿童仍在发作。14名儿童从一种癫痫综合征演变为另一种。在最后一次随访时（中位年龄12.7岁；最小年龄9.7岁），80%的儿童已有超过2年未发作癫痫。
与CP和WMI相关的癫痫发作疾病的电临床特征是儿童期有限年龄的癫痫综合征，大多数预后良好。这些发现对咨询和药物治疗具有重要意义。
