摘要
目的探讨脑囊虫病继发癫痫的临床特点、治疗方法、疗程、疗效及并发症。方法回顾性分析2011年1月至2016年12月我院收治的河南地区脑囊虫病继发癫痫10例患者的临床表现、癫痫发作形式、影像学动态变化特点、疗法和疗效。结果所有患者均继发癫痫发作,头痛8例,精神症状5例,视力下降4例,伴局灶性神经功能损害体征7例。影像学提示多发脑实质型6例,多发脑实质型并脑室型、单发脑实质型、蛛网膜下腔型及钙化型各1例。EEG监测均发现明显异常。予抗囊虫药物治疗9例,其中吡喹酮单药治疗3例,阿苯达唑单药治疗1例,吡喹酮联合阿苯达唑治疗5例,手术治疗3例。随访2.5~8年,10例患者恢复均较好,其中囊虫影完全消失8例,残留点状炎性结节1例。癫痫发作完全缓解8例,多发脑实质型及蛛网膜下腔型各1例,在规律服用抗癫痫药物的情况下偶有发作。无病情恶化病例。结论多疗程吡喹酮联合阿苯达唑驱虫、长期规律足量应用抗癫痫药物及手术切除单发脑实质囊虫是治疗脑囊虫病继发癫痫的有效方法。
Objective To probe clinical characteristics,treatment methods,treatment course,curative effect and complications of secondary epilepsy by neurocysticercosis.Methods The clinical deta of 10 patients suffering from secondary epilepsy due to neurocysticercosis in Henan province treated in our hospital from January 2011 to December 2016 were retrospectively analyzed,including clinical manifestations,types of epileptic seizure,characteristics of imaging dynamic changes,therapies and effects.Results All of cases were summarized,secondary seizures in 10 cases,headache in 8 cases,mental symptom in 5 cases,vision declined in 4 cases,focal neurological impairment in 7 cases.Imageology showed multiple brain tissue type cysticercosis in 6 cases,multiple brain tissue type and ventricle cysticercosis 1 case,single brain tissue type cysticercosis 1 case,subarachnoid space type cysticercosis 1 case,calcification type cysticercosis 1 case.Obvious abnormalities were found in all EEG monitoring.Anticysticercosis therapies were given in 9 cases,including alone praziquantel in 3 cases,alone albendazole in 1 case,praziquantel combining with albendazole in 5 cases,surgical treatments were given in 3 cases.All of cases were followed-up from 2.5 years to 8 years,total 10 patients got a good recovery,including cysticercosis completely disappeared in 8 cases,residual punctate inflammatory nodules in 1 case.The epileptic seizure was completely relieved,2 cases including 1 as multiple brain tissue type and 1 as subarachnoid space type cysticercosis got occasional seizure when took medicine normatively.No worsening cases.Conclusion Management that multiple courses of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis,long-term and adequate use of antiepileptic drugs and surgical resection single brain cysticercosis are effective treatments for secondary epilepsy by neurocysticercosis.
作者
郭效东
路小奇
王振华
徐鹏
刘明辉
郝文明
杨新超
李经纶
姚安会
王本瀚
GUO Xiao-dong;LU Xiao-qi;WANG Zhen-hua(Department of Neurosurgery,988rd Hospital of PLA,Zhengzhou 450042,China)
出处
《临床神经病学杂志》
CAS
2020年第6期439-445,共7页
Journal of Clinical Neurology
基金
河南省医学科技攻关计划科研项目(LHGJ20190868)。
关键词
脑囊虫病
继发性癫痫
疗效
外科手术
neurocysticercosis
secondary epilepsy
curative effect
surgery
