睡眠期癫痫电状态:危险因素、临床过程和治疗方法

IF 0.3 Q4 PEDIATRICS Journal of Child Science Pub Date : 2023-01-01 DOI:10.1055/s-0043-1768463
I. Aleksandrova, A. Asenova, P. Dimova, D. Deneva, E. Rodopska, E. Slavkova, V. Bojinova
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引用次数: 0

摘要

摘要背景 临床医生的工作重点是确定睡眠中癫痫持续状态(ESES)表现的预测因素,因为ESES对认知的负面影响。由于治疗耐药性,治疗方法仍然是一个主要问题。客观的 我们寻找ESES表现的潜在危险因素,并总结特发性和症状性ESES患者的临床病程和治疗方法。患者和方法 我们回顾性分析了51例特发性ESES患儿和20例有症状ESES患儿的医学资料。后果 我们观察到癫痫发作的年龄较早(p = 0.0002),并且多发性癫痫的病例比例更高(p < 0.00001)和发作后麻痹(p < 0.00001)与具有中央颞棘波的儿童期癫痫进行比较。在特发性ESES中,治疗包括皮质类固醇激素治疗永久性ESES缓解和短暂性ESES的患者,左乙拉西坦(LEV)儿童永久性ESES缓解和暂时性ESES,氯硝西泮(CZP)儿童持久性ESES减轻和暂时性ESES,乙磺酰亚胺(ESM)和舒噻肟。有症状的ESES患者有更不利的演变,因为19名儿童的ESES病程持续或复发。结论 我们认为癫痫发作的早期年龄(5岁以下)以及多发性癫痫发作和发作后麻痹是ESES表现的危险因素。ESES的特点是具有显著的治疗耐药性,尤其是在有症状的病例组中。使用LEV、ESM、CZP和类固醇观察到良好的结果。
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Electrical Status Epilepticus during Sleep: Risk Factors, Clinical Course, and Treatment Approaches
Abstract Background  The efforts of clinicians are focused on determining the predictors for electrical status epilepticus in sleep (ESES) manifestation, due to the negative effect of ESES on cognition. Treatment approaches remain a leading problem because of therapeutic resistance. Objective  We looked for potential risk factors for ESES manifestation and summarize the clinical course and therapeutic approaches in patients with idiopathic and symptomatic ESES. Patients and Methods  We retrospectively reviewed the medical data of 51 children with idiopathic ESES and 20 children with symptomatic ESES. Results  We observed an earlier age of seizure onset ( p  = 0.0002) and a higher percentage of cases with multiple seizures ( p  < 0.00001) and with postictal paralysis ( p  < 0.00001) in idiopathic ESES compared with childhood epilepsy with centrotemporal spikes. In the idiopathic ESES, the treatment consisted of corticosteroids in patients with permanent ESES remission and transient remission, levetiracetam (LEV) children with permanent ESES remission and transient, clonazepam (CZP) children with permanent ESES remission and transient, ethosuximide (ESM), and sulthiame. The patients with symptomatic ESES had more unfavorable evolution, as 19 children had persistent or relapsing ESES course. Conclusion  We consider the earlier age of seizure onset (below 5 years) and the presence of multiple seizures and postictal paresis as risk factors for ESES manifestation. ESES is characterized by a significant therapeutic resistance, especially in the group of symptomatic cases. Good results are observed with LEV, ESM, CZP, and steroids.
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