目的 探讨脑室周围白质软化(PVL)相关脑性瘫痪共患癫痫的临床特征及影响因素,为早期预警及个体化干预提供依据。方法 回顾性分析2018年6月—2024年9月深圳市儿童医院收治的142例6岁以上PVL相关脑瘫儿童的病例资料,按癫痫发生情况分为共患癫痫组与未共患癫痫组,采用单因素分析及多因素logistic回归分析共患癫痫影响因素。结果 共75例患儿共患癫痫,共患癫痫病例首次发作中位年龄为23月龄,84.0%(63/75)表现为单一发作形式,局灶性发作(28.0%)最常见。72.0%的病例通过单药(38.7%)或联合用药(33.3%)可控制癫痫发作。单因素分析显示,两组间新生儿惊厥史、新生儿机械通气史(χ2=5.382)、出生窒息史(χ2=7.826)、异常脑电图(χ2=25.352)、PVL分级(χ2=28.495)、粗大运动功能分级(GMFCS)、小头畸形(χ2=21.816)、脑瘫分型(χ2=11.077)差异有统计学意义(P<0.05)。多因素logistic回归分析显示,异常脑电图(OR=9.622, 95%CI: 2.415~38.330)、中度PVL(OR=3.939,95%CI:1.678~9.247)、重度PVL(OR=5.358, 95%CI: 1.804~15.909)、痉挛型四肢瘫(OR=3.376,95%CI:1.134~10.051)是PVL相关脑瘫共患癫痫的危险因素(P<0.05)。结论 PVL相关脑瘫儿童共患癫痫多见于幼儿期,以局灶性发作为主,药物控制率较高。中重度PVL、痉挛型四肢瘫、异常脑电图是其独立危险因素,应对此类高危群体加强早期监测与干预。
Abstract
Objective To investigate the clinical characteristics and risk factors for epilepsy comorbidity in children with periventricular leukomalacia (PVL)-associated cerebral palsy (CP), so as to provide a basis for early warning and individualized intervention. Methods A retrospective analysis was conducted, including 142 children aged over 6 years with PVL-related CP admitted to Shenzhen Children's Hospital between June 2018 and September 2024. Participants were divided into two groups based on the presence or absence of epilepsy comorbidity. Demographic, perinatal, clinical, and neuroimaging data were collected. Univariate and multivariate logistic regression analyses were used to identify influencing factors for epilepsy comorbidity. Results Seventy-five children (52.8%) had comorbid epilepsy. The median age at first seizure was 23 months. A single seizure type was observed in 84.0% (63/75) of cases, with focal seizures (28.0%) being the most common. Seizures were controlled with monotherapy in 38.7% of cases and with polytherapy in 33.3%. Univariate analysis showed there are significant differences in neonatal seizure history, neonatal mechanical ventilation history(χ2=5.382), birth asphyxia history(χ2=7.826), abnormal EEG(χ2=25.352), PVL grading(χ2=28.495),gross motor function classification system(GMFCS), microcephaly(χ2=21.816), and CP classification(χ2=11.077) between the two groups (P<0.05). Multivariate logistic regression analysis identified abnormal EEG (OR =9.622, 95%CI: 2.415 - 38.330), moderate PVL (OR =3.939, 95%CI: 1.678 - 9.247), severe PVL (OR =5.358, 95%CI: 1.804 - 15.909), and spastic quadriplegia (OR =3.376, 95%CI: 1.134 - 10.051) as independent risk factors for epilepsy comorbidity in children with PVL-related CP (P<0.05). Conclusions Epilepsy comorbidity in children with PVL-related CP predominantly occurs in early childhood, characterized mainly by focal seizures and a relatively high rate of medication control.Moderate or severe PVL, spastic quadriplegia, and abnormal EEG are independent risk factors, warranting enhanced early monitoring and intervention for this high-risk population.
关键词
脑室周围白质软化 /
脑性瘫痪 /
癫痫 /
痉挛型四肢瘫 /
脑电图
Key words
periventricular leukomalacia /
cerebral palsy /
epilepsy /
spastic quadriplegia /
electroencephalography
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基金
广东省医学科学技术研究基金项目(A2022421);汕头大学医学院2024年教学改革与教学研究项目(24JXGG29)
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