脑电变化和BASED评分与54例婴儿痉挛症促肾上腺皮质激素疗效的相关性

doi:10.6040/j.issn.1671-7554.0.2022.0654

摘要/Abstract

摘要： 目的探讨婴儿痉挛症患者促肾上腺皮质激素(ACTH)治疗后脑电图变化特征及其对疗效的评估价值。方法回顾性分析2019年11月至2021年4月首都医科大学附属北京儿童医院神经内科确诊为婴儿痉挛症并给予ACTH治疗的54例患者临床及脑电图资料并进行随访。脑电图分析内容包括发作间期背景活动异常(主要是慢波)、癫痫样放电(癫痫样波形和高度失律)。采用波幅负荷和癫痫样放电评分(BASED)系统进一步评价ACTH治疗前后脑电图变化。根据ACTH治疗后14 d时是否有癫痫发作分为无发作组(n=29例)和发作组(n=25例),对两组治疗前后的EEG进行比较。结果治疗后无发作组中局灶性慢波(18例)、局灶与多灶性癫痫样放电(28例)明显高于发作组(5例、15例),高度失律(1例)明显少于发作组(10例),两组差异均有统计学意义(P<0.05)。无发作组BASED提示治疗后脑电图缓解(26例)明显高于发作组(7例)(P<0.000 1),脑电图缓解与临床疗效一致(P<0.001)。随访12~29个月,无发作组9例复发,发作组16例仍有痉挛发作,痉挛发作控制率分别为68.97%、36%。结论发作间期脑电图的特点与临床疗效具有一定相关性,BASED显示ACTH治疗后脑电图缓解时,提示临床疗效好,BASED量化可协助临床的疗效判断。

关键词: 婴儿痉挛症, 促肾上腺皮质激素, 视频脑电图, 癫痫样放电评分, 预后

Abstract: Objective To explore the characteristics of electroencephalogram(EEG)after adrenocorticotropic hormone(ACTH)treatment and the efficacy in patients with infantile spasm(IS). Methods Clinical and EEG data of 54 IS patients treated with ACTH during Nov. 2019 and Apr. 2021 were retrospectively analyzed. EEG analysis included background activity(slow waves)and epileptic discharges(epileptic waves and hypsarrhythmia). Changes of EEG before and after ACTH treatment were evaluated with burden of amplitudes and epileptiform discharges score(BASED). According to whether epileptic seizure occurred 14 days after ACTH treatment, the patients were divided into none-seizure group(n=29)and seizure group(n=25). The changes of EEG before and after ACTH treatment were compared between the groups. Results Focal slow wave was observed in 18 cases and focal epileptic wave in 28 cases in the non-seizure group, which were significantly higher than those in the seizure group(P<0.05), while hypsarrhythmia was observed in 1 case in the non-seizure group, which was significantly lower than that in the seizure group(P<0.05). BASED results showed that EEG remission was observed in 26 cases in the non-seizure group, which was significantly higher than that in the seizure group(7 cases, P<0.000 1), and the EEG remission was consistent with the clinical efficacy(P<0.001). During the follow-up of 12 to 29 months, spasm recurred in 9 and 16 cases in the non-seizure group and seizure group, respectively, and the control rates of spasm were 68.97% and 36%, respectively. Conclusion There is a certain correlation between the characteristics of interictal EEG and clinical efficacy. The BASED result shows that EEG remission after ACTH treatment indicates good clinical efficacy. Thus, the quantification on BASED can assist the evaluation of clinical efficacy.

Key words: Infantile spasm, Adrenocorticotrophic hormone, Video electroencephalogram, Burden of amplitudes and epileptiform discharges score, Prognosis

中图分类号:

R742.1

郑苏,陈述花,李华,邓劼,陈春红,王晓慧,冯卫星,韩萧迪,张雨佳,李娜,李莫,方方. 脑电变化和BASED评分与54例婴儿痉挛症促肾上腺皮质激素疗效的相关性[J]. 山东大学学报 (医学版), 2022, 60(9): 91-96.

ZHENG Su, CHEN Shuhua, LI Hua, DENG Jie, CHEN Chunhong, WANG Xiaohui, FENG Weixing, HAN Xiaodi, ZHANG Yujia, LI Na, LI Mo, FANG Fang. Correlation between EEG variations and BASED evaluation of the efficacy of ACTH treatment in 54 cases of infantile spasms[J]. Journal of Shandong University (Health Sciences), 2022, 60(9): 91-96.

参考文献

[1] Gonzalez-giraldo E, Stafstrom CE, Stanfield AC, et al. Treating infantile spasms with high-dose oral corticosteroids:a retrospective review of 87 children[J]. Pediatr Neurol, 2018, 87: 30-35. doi: 10.1016/j.pediatrneurol.2018.06.011.
[2] Kelley SA, Knupp KG. Infantile spasms-have we made progress?[J]. Curr Neurol Neurosci Rep, 2018, 18(5): 27.
[3] Demarest ST, Shellhaas RA, Gaillard WD, et al. The impact of hypsarrhythmia on infantile spasms treatment response: observational cohort study from the National Infantile Spasms Consortium[J]. Epilepsia, 2017, 58(12): 2098-2103.
[4] Seigo K, Yusaku M, Kazuhiro M, et al. A fact-finding survey of the recommendation on sedation during physiological examinations such as electroencephalogram in Japan[J]. Brain Dev, 2021, 43(2): 208-213.
[5] Ocallaghan FJK, Edwards SW, Alber FD, et al. Vigabatrin with hormonal treatment versus hormonal treatment alone(ICISS)for infantile spasms: 18-month outcomes of an open-label,randomised controlled trial[J]. Lancet Child Adolesc Health, 2018, 2(10): 715-725.
[6] Auvin S, Hartman AL, Desnous B, et al. Diagnosis delay in West syndrome: misdiagnosis and consequences[J]. Eur J Pediatr, 2012, 171(11): 1695-1701.
[7] Mytinger JR, Weber A, Heyer GL. The response to ACTH is determined early in the treatment of infantile spasms[J]. Epileptic Disord, 2015, 17(1): 52-57.
[8] Dressler A, Benninger F, Trimmel-schwahofer P, et al. Efficacy and tolerability of the ketogenic diet versus high-dose adrenocorticotropic hormone for infantile spasms:a single-center parallel-cohort randomized controlled trial[J]. Epilepsia, 2019, 60(3): 441-451.
[9] Rosati A, Ilvento L, Lucenteforte E, et al. Comparative efficacy of antiepileptic drugs in children and adolescents:a net-work meta-analysis[J]. Epilepsia, 2018, 59(2): 297-314.
[10] Hamano, Toshisaburo, Nagai, et al. Treatment of infantile spasms by pediatric neurologists in Japan[J]. Brain & Development, 2018, 40(8): 685-692.
[11] Mytinger JR, Vidaurre J, Moore-Clingenpeel M, et al. Albert DVF.A reliable interictal EEG grading scale for children with infantile spasms-The 2021 BASED sore[J]. Epilepsy Res, 2021, 173: 106631. doi: 10.1016/j.eplepsyres.2021.106631.
[12] Go CY, Mackay MT, Weiss SK, et al. Evidence-based guideline update: medical treatment of infantile spasms: report of the guideline development subcommittee of the american academy of neurology and the practice committee of the child neurology society[J]. Neurology, 2012, 78(24): 1974-1980.
[13] Watanabe K, Negoro T, Okumura A. Symptomatology of infantile spasms[J]. Brain & Development, 2001, 23(7): 453-66.
[14] Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology[J]. Epilepsia, 2017, 58(4): 512-521.
[15] 刘昆明. 丙戊酸联合拉莫三嗪治疗各型癫痫的疗效及安全性[J]. 中国实用医药, 2016, 11(25): 149-150. LIU Kunming. Efficacy and safety of valproic acid combined with lamotrigine in the treatment of various types of epilepsy[J]. China Practical Medical, 2016, 11(25): 149-150.
[16] Taghdiri MM, Nemati H. Infantile spasm: a review article[J]. Iran J Child Neurol, 2014, 8(3): 1-5.
[17] Kelley SA, Knupp KG. Infantile spasms-have we made progress?[J]. Curr Neurol Neurosci Rep, 2018, 18(5): 27.
[18] 王翠欣, 刘书海, 高晓峰, 等. 高度失律脑波在动态脑电图中的不同构型变化[J]. 现代电生理学杂志, 2002, 9(4): 159-160. WANG Cuixin, LIU Shuhai, GAO Xiaofeng, et al. The different conformational change of the brain wave of the hypsarrhythmia in AEEG[J]. JMEP, 2002, 9(4): 159-160.
[19] Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: task force report for the ILAE Commission of pediatrics[J]. Epilepsia, 2015, 56(8): 1185-1197.
[20] Pellock JM, Hrachovy R, Shinnar S, et al. Infantile spasms: a US consensus report[J]. Eplilepsia, 2010, 51(10): 2175.
[21] 邓巍, 黄婷婷. 91例癫痫儿童临床表现及脑电图分析[J]. 神经损伤与功能重建, 2017, 12(5): 413-414. DENG Wei, HUANG Tingting. Analysis of clinical features and electroencephalograms of ninety-one children with epilepsy[J]. Neural Injury And Functional Reconstruction, 2017, 12(5): 413-414.
[22] 孙于林, 陈健, 杨光. 脑电图评分在婴儿痉挛症的应用进展[J]. 中华实用儿科临床杂志, 2021, 36(10): 794-797. SUN Yulin, CHEN Jian, YANG Guang. Progress in the application of electroencephalography scores in infantile spasm[J]. Chinese Journal of Clinical Pediatrics, 2021, 36(10): 794-797.
[23] Hayashi Y, Yoshinaga H, Akiyama T, et al. Predictive factors for relapse of epileptic spasms after adrenocorticotropic hormone therapy in West syndrome[J]. Brain & Development, 2016, 38(1): 32-39.
[24] Lux AL, Osborne JP. A proposal for case definitions and outcome measures in studies of infantile spasms and west syndrome:consensus statement of the west delphi group[J]. Epilepsia, 2004, 45(11): 1416-1428.
[25] 刘晓燕. 临床脑电图学[J]. 2版. 北京: 人民卫生出版社, 2017: 126-127.

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