成人非惊厥性癫痫持续状态患者的临床及脑电图特征

张敏+马煦+杨春晓

[摘要] 目的 探讨成人非惊厥性癫痫持续状态（NCSE）患者的临床及脑电图特征，以提高对NCSE的认识，避免漏诊及误诊。 方法 对2013年6月～2017年6月哈尔滨医科大学附属第一医院和哈尔滨医科大学附属第二医院共9例确诊或高度怀疑为NCSE患者的病因、临床表现、脑电图特征及预后进行分析。 结果 9例NCSE患者，急性病因5例，慢性病因2例，未发现特殊病因2例。4例患者发作期通过简易精神状态量表（MMSE）检查，均发现认知功能下降，5例不能配合量表检查。治疗后MMSE量表评估，3例评分较前提高，1例变化不明显。9例患者脑电图均见异常，伴明确癫痫样放电7例，弥漫性慢波背景上节律性delta慢波发放1例，间断背景解体伴慢波发放有演变1例。5例患者经治疗后症状缓解，1例治疗后仍有发作，1例病情恶化，2例死亡。 结论 NCSE病因、临床表现及脑电图均较复杂，提高对NCSE的认识及给予及时的脑电图检查是确诊的关键。预后与病因密切相关，可治性病因导致的NCSE预后较好。

[关键词] 非惊厥性癫痫持续状态；病因；临床表现；脑电图

[中图分类号] R742.1 [文献标识码] A [文章编号] 1673-7210（2018）01（b）-0062-04

[Abstract] Objective To investigate the clinical and EEG features of 9 cases of nonconvulsive status epilepticus （NCSE） with the purpose of increasing cognition of the disease and avoiding missed diagnosis. Methods Nine cases diagnosed or highly suspected of NCSE from the First Affiliated Hospital of Harbin Medical University and the Second Affiliated Hospital of Harbin Medical University from June 2013 to June 2017 were selected， their etiological， clinical manifestations， EEG features and prognosis were analyzed. Results Among 9 NCSE patients， there were 5 cases with acute etiological factors， 2 cases with chronic etiological factors and 2 cases without any special disease. Four patients′cognitive ability was assessed by the mini-mental state examination （MMSE） scale at the stage of attack and cognitive disorder was found， 5 patients can't cooperate with the test. Three patients′ grades were improved after treatment， one was in line with before. All 9 patients presented EEG abnormal with multiple patterns， 7 cases with epileptic discharge， one with slow waves background and rhythmic delta waves discharge， one with EEG background break up accompany slow-wave gave out. Five cases′ seizure remitted after treatment， one case still had a seizure， one with the illness worsened， two cases were dead. Conclusion The etiological， clinical and EEG of NCSE are complex. Increasing cognition of the disease and giving EEG test timely is vital for diagnosis. The prognosis is in line with the etiological， patients with curable etiological factors of NCSE may have an ideal prognosis.

[Key words] Nonconvulsive status epilepticus； Etiological factors； Clinical manifestations； EEG

癲痫持续状态（status epilepticus，SE）是神经科较常见的危急重症之一，2015年国际抗癫痫联盟（international league against epilepsy，ILAE）按SE症状学进行分类，分为具有显著运动症状的SE（convulsive status epilepticus，CSE）和不伴显著运动症状的SE（nonconvulsive status epilepticus，NCSE）[1]。NCSE病因复杂，临床表现常不典型，容易被漏诊及误诊。近年来，由于脑电图（EEG）监测技术的发展，使越来越多的NCSE患者能够得到有效的诊断与治疗。为提高对本病的认识，现对9例确诊或高度怀疑为NCSE患者的病因、临床表现、EEG特征进行总结。endprint