Nishimoto Shizuka, Kitai Yukihiro, Hirai Satori, Hirotsune Mika, Okuyama Naomi, Hirano Shodo, Mogami Yukiko, Arai Hiroshi
Department of Pediatric Neurology, Bobath Memorial Hospital, Osaka, Japan.
Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Eur J Paediatr Neurol. 2023 Nov;47:41-46. doi: 10.1016/j.ejpn.2023.09.006. Epub 2023 Sep 7.
To elucidate the incidence and outcomes of childhood-onset epilepsy and associated factors in term-born patients with basal ganglia and thalamic lesion (BGTL)-induced dyskinetic cerebral palsy (DCP) caused by perinatal hypoxic-ischemic encephalopathy (HIE).
We studied 104 term-born patients with BGTL-induced DCP (63 males and 41 females, aged 2-22 years) to investigate the incidence of epilepsy and the factors related to its development. We used multivariate analysis to assess perinatal factors, gross motor function, and the extent of brain lesions. We also investigated the seizure onset, clinical course, and electroencephalography (EEG) characteristics.
The cumulative epilepsy incidence was 36%. Multiple logistic regression analysis revealed that deep white matter lesions were the only independent risk factor for epilepsy. The confirmed seizure types included epileptic spasms (ES, n = 13), myoclonic seizures (MS, n = 6), and focal-onset seizures (FS, n = 24). Only patients with deep white matter lesions exhibited ES or MS. The symptoms of FS resembled those of self-limited epilepsy with centrotemporal spikes; however, only half of the patients reached remission by the time of investigation, and four patients had more than one seizure per month despite appropriate drug therapy. Focal spikes in the peri-rolandic area were detected not only in patients with FS but also in half of the patients without epilepsy.
One-third of term-born patients with BGTL-induced DCP caused by perinatal HIE develop epilepsy, and deep white matter lesions increase the likelihood of epilepsy. Preparation for early-onset ES, MS, and subsequent FS is beneficial.
阐明足月出生的围产期缺氧缺血性脑病（HIE）所致基底节和丘脑病变（BGTL）引起的运动障碍型脑瘫（DCP）患儿癫痫的发病率、结局及相关因素。
我们研究了104例足月出生的BGTL所致DCP患者（男63例，女41例，年龄2 - 22岁），以调查癫痫的发病率及其发生相关因素。我们采用多变量分析来评估围产期因素、粗大运动功能和脑损伤程度。我们还研究了癫痫发作起始、临床病程及脑电图（EEG）特征。
累积癫痫发病率为36%。多因素logistic回归分析显示，深部白质病变是癫痫的唯一独立危险因素。确诊的癫痫发作类型包括癫痫性痉挛（ES，n = 13）、肌阵挛发作（MS，n = 6）和局灶性发作（FS，n = 24）。仅深部白质病变的患者出现ES或MS。FS的症状类似于伴有中央颞区棘波的自限性癫痫；然而，到调查时只有一半的患者缓解，4例患者尽管接受了适当的药物治疗仍每月发作超过1次。不仅FS患者，而且一半无癫痫的患者在中央前回周围区域检测到局灶性棘波。
三分之一的足月出生的围产期HIE所致BGTL引起的DCP患者会发生癫痫，深部白质病变增加癫痫发生的可能性。对早期发作的ES、MS及随后的FS做好准备是有益的。
