摘要
目的探讨大剂量地西泮（DZP）在伴睡眠中癫痫性电持续状态（ESES）癫痫患儿中的应用及疗效。方法对2016年10月至2017年5月在北京大学第一医院儿科门诊就诊的9例ESES癫痫患儿给予大剂量DZP口服治疗，治疗方案：第1晚0.75～1.00 mg/kg（最大量40 mg），第2晚起0.5 mg/（kg·d）（最大量20 mg），维持1～3个月，随后1～3个月逐渐减停。观察患儿应用DZP前后的癫痫发作、脑电图（EEG）变化情况及药物不良反应。结果9例患儿中男6例、女3例。起病年龄为1岁6个月～10岁。儿童良性癫痫伴中央颞区棘波变异型5例，癫痫性脑病伴睡眠中持续棘慢波1例，3例为ESES相关癫痫，未诊断具体的癫痫综合征。DZP开始治疗年龄为4岁4个月～12岁，DZP用药时间为1～5个月（1例仅第1晚用药），随访时间6～12个月。DZP对发作的疗效：5例显效，2例有效，2例无效；总有效率为78%（7/9例）。DZP治疗1个月时对EEG的疗效：2例显效（EEG转为正常），3例有效，2例无效；总有效率为71%（5/7例），2例患儿未复查EEG。7例癫痫发作疗效为显效及有效的患儿中4例（57%）分别在在减药期间和减停后出现复发，EEG随之异常或放电增多。DZP的不良反应：3例（33%）出现不良反应，2例表现为用药早期尿床，1例用药第1天晚上因打鼾而随后停药。结论大剂量DZP对伴ESES癫痫的患儿在控制癫痫发作及改善ESES有一定疗效，同时也有一定的复发率，不良反应相对少见，且程度较轻。对难治性ESES癫痫患儿，病程中可应用大剂量DZP治疗以缓解病情。
ObjectiveTo explore the therapeutic effects and adverse reaction of high-dose Diazepam （DZP） in patients with electrical status epilepticus during sleep （ESES）.MethodsNine patients in the Outpatient of the Department of Pediatrics, Peking University First Hospital from October 2016 to May 2017 with ESES were treated with high-dose DZP.Oral DZP was administered in a dose of 0.75-1.00 mg/kg（maximum： 40 mg） during the first night followed by 0.5 mg/（kg·d） （maximum： 20 mg） from the second night for 1-3 months and tapered over next 1-3 months.The seizures, electroencephalogram （EEG） changes and adverse reactions were observed before and after DZP treatment.ResultsSix of 9 patients were male and 3 were female.The age of onset was ranged from 1 year and 6 months to 10 years.Benign childhood epilepsy with central temporal spike was diagnosed in 5 cases, epileptic encephalopathy with continuous spike-and-wave during sleep in 1 case, and ESES related epilepsy in 3 cases.Age of onset DZP treatment ranged from 4 years and 4 months to 12 years, and the duration of DZP treatment was ranged from 1 to 5 months （1 case only for the first night）. The follow-up interval was 6-12 months.The efficiency of DZP on seizures： intent effective in 5 patients, effective in 2 patients and ineffective in 2 patients, and the effective rate was 78% （7/9 cases）. The efficiency of DZP on EEG （1 month after DZP treatment）： intent effective in 2 patients （EEG norma-lized）, effect in 3 patients and no effect in 2 patients, and the effective rate was 71% （5/7 cases）, while 2 patients did not receive EEG examination.Four of 7 patients （57%） with intent effect and effective of DZP on seizures had seizures relapse during drug reduction and after drug withdrawal, and the EEG deteriorated simultaneously.Adverse reactions of DZP included 3 patients （33%） with adverse reactions, bed-wetting in 2 patients and snoring on the first night in 1 patient who withdrew DZP later.ConclusionsThe high-dose of DZP has a certain effect on seizures control and ESES suppression in patients with ESES, but also has a certain recurrence rate.The adverse reactions are mild and self-limiting.High-dose DZP treatment could be a choice for refractory patients with ESES to alleviate disease.
作者
龚潘
薛姣
杨志仙
金怡汶
吴晔
常杏芝
姜玉武
张月华
Gong Pan;Xue Jiao;Yang Zhixian;Jin Yiwen;Wu Ye;Chang Xingzhi;Jiang Yuwu;Zhang Yuehua(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2018年第21期1645-1648,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
国家自然科学基金（81771393）
北京市科学技术委员会资助项目（Z171100001017125）
北京大学医学-信息科学交叉学科种子基金（BMU20160586）
关键词
睡眠中癫痫性电持续状态
地西泮
癫痫
Electrical status epilepticus during sleep
Diazepam
Epilepsy
