Revilla Orías M Daniela, Alonso Xenia, Campistol Jaume, Macaya Alfons, Escofet Conchita, Fons Carmen
Servicio de Neuropediatría Hospital Sant Joan de Déu, Barcelona, España. E-mail:
Servicio de Neuropediatría Hospital Sant Joan de Déu, Barcelona, España.
Medicina (B Aires). 2019;79 Suppl 3:6-9.
The objective was to describe the frequency, mode of presentation and characteristics of epilepsy in children with congenital hemiparesis (CH). It is a etrospective, descriptive and multicenter study, based on the collection of data from the clinical records of patients from 0 to 19 years with CH secondary to perinatal infarction in different centers of the community of Catalonia. A total of 310 children were included (55% males and 45% females), from a total of 13 centers in Catalonia. Average age of onset of the crises was 2 ± 1 year. Epilepsy was present in 29.5% (n = 76), among which the most frequent vascular subtype was arterial presumed perinatal ischemic stroke (51.3%), followed by neonatal arterial ischemic stroke (18.4%), periventricular venous infarction (15.8%), neonatal hemorrhagic stroke (10.5%) and neonatal cerebral sinovenous thrombosis (3.9%). Semiology of the most frequent seizures was motor focal in 82%, followed by focal motor with secondary bilateralization in 23%, focal discognitive in 13.5%, generalized by 2% and spasms in 6.5%. The 67.3% were controlled with monotherapy and the drugs used were valproate, levetiracetam or carbamazepine. The antecedent of electrical status during sleep was identified in 3 patients, all associated with extensive lesions that included the thalamus. Of the total number of children with epilepsy, 35% began with neonatal seizu res in the first 3 days of life. The 30% of children with perinatal stroke and CH present a risk of epilepsy during childhood. Children with ischemic strock have the highest risk, so they will require a follow-up aimed at detecting prematurely the epilepsy and start a treatment.
目的是描述先天性偏瘫（CH）患儿癫痫的发生率、表现方式及特征。这是一项回顾性、描述性多中心研究，基于加泰罗尼亚社区不同中心0至19岁因围产期梗死继发CH的患者临床记录收集数据。共纳入310名儿童（55%为男性，45%为女性），来自加泰罗尼亚的13个中心。发作的平均起始年龄为2±1岁。癫痫的发生率为29.5%（n = 76），其中最常见的血管亚型是推测的围产期动脉缺血性卒中（51.3%），其次是新生儿动脉缺血性卒中（18.4%）、脑室周围静脉梗死（15.8%）、新生儿出血性卒中（10.5%）和新生儿脑静脉窦血栓形成（3.9%）。最常见发作的症状学表现为82%为局灶性运动发作，其次是23%的局灶性运动发作继发双侧化，13.5%为局灶性认知障碍发作，2%为全身性发作，6.5%为痉挛发作。67.3%的患者通过单一疗法得到控制，使用的药物为丙戊酸盐、左乙拉西坦或卡马西平。3例患者被确定有睡眠期电持续状态，均与包括丘脑在内的广泛病变相关。在所有癫痫患儿中，35%在出生后的头3天开始出现新生儿惊厥。30%的围产期卒中合并CH患儿在儿童期有癫痫发作风险。缺血性卒中患儿的风险最高，因此需要进行随访，以便早期发现癫痫并开始治疗。
