睡眠中癫痫电持续状态（ESES）-极高棘慢波指数儿童的治疗模式和 EEG 结果。
Electrical status epilepticus in sleep (ESES) - Treatment pattern and EEG outcome in children with very high spike-wave index.
机构信息
Department of Neurology, Children's National Health System, George Washington University, Washington DC, United States of America.
Department of Neurology, Children's National Health System, George Washington University, Washington DC, United States of America.
出版信息
Epilepsy Behav. 2020 Apr;105:106965. doi: 10.1016/j.yebeh.2020.106965. Epub 2020 Mar 8.
OBJECTIVE
The objective of the study was to determine electrical status epilepticus in sleep (ESES) outcome in children with very high spike-wave index (SWI; ≥85%), and assess treatment pattern.
METHODS
Medical records of children 1-17 years old with ESES were reviewed. In this study, ESES is defined as SWI in non-rapid eye movement (non-REM) sleep of ≥85%. Electrical status epilepticus in sleep resolution is defined as reduction of SWI to <50%.
RESULTS
Complete data were available in 33 children. Age at ESES diagnosis ranged from 32 to 165 months, median 76 months. The median duration of follow-up was 33 months. Two-thirds of the children were on one or more antiepileptic drugs (AED) at ESES diagnosis. Antiepileptic drugs were used as first treatment for ESES in 24/33 (73%). Electrical status epilepticus in sleep initially resolved in 76%, but 56% had subsequent relapse. The relapse rate was higher for steroids (89%) and benzodiazepines (60%) as compared with nonbenzodiazepine AEDs (29%). At last follow-up, ESES resolved in 21 children (64%). Electrical status epilepticus in sleep resolution was associated with seizure freedom (Fisher's exact, p < 0.05).
SIGNIFICANCE
Using electroencephalogram (EEG) criteria, ESES resolved in 64%. We found high failure rate of first-line AEDs in preventing ESES, and high relapse rate. Standardization of ESES management is urgently needed.
目的
本研究旨在确定极高棘慢波指数（SWI；≥85%）儿童睡眠中癫痫电持续状态（ESES）的结局，并评估治疗模式。
方法
回顾了 1-17 岁 ESES 患儿的病历。在本研究中，ESES 定义为非快速眼动（非 REM）睡眠中 SWI 为≥85%。ESES 缓解定义为 SWI 降低至＜50%。
结果
33 例患儿的完整数据可用。ESES 诊断时的年龄为 32-165 个月，中位数为 76 个月。中位随访时间为 33 个月。三分之二的患儿在 ESES 诊断时使用了一种或多种抗癫痫药物（AED）。24/33（73%）例患儿将 AED 作为 ESES 的一线治疗。ESES 最初缓解率为 76%，但 56%患儿随后复发。与非苯二氮䓬类 AED（29%）相比，类固醇（89%）和苯二氮䓬类（60%）的复发率更高。最后一次随访时，21 例患儿（64%）ESES 缓解。ESES 缓解与无癫痫发作有关（Fisher 确切检验，p<0.05）。
意义
使用脑电图（EEG）标准，ESES 缓解率为 64%。我们发现，一线 AED 预防 ESES 的失败率较高，复发率也较高。迫切需要 ESES 管理的标准化。
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