目的 探讨小儿脑性瘫痪合并癫痫的临床特点及危险因素,为有效治疗提供参考依据。 方法 对522例脑性瘫痪患儿(合并癫痫92例,无合并癫痫430例)的高危因素、影像学资料等进行回顾性分析,并对合并癫痫的92例从临床发作特点、瘫痪类型及智力发育水平进行分析。 结果 522例脑瘫患儿合并癫痫的发生率是17.6%。低出生体重、颅内出血可作为小儿脑性瘫痪合并癫痫的危险因素(χ²=6.564和11.797,P均<0.05),而早产、窒息、黄疸两组间比较无统计学意义(P>0.05)。在影像学检查结果中,脑软化灶及脑结构畸形为癫痫的预测风险因子(χ²=5.250和14.020,P均<0.05),而脑发育不良、脑室扩大两组间比较差异无统计学意义(P>0.05)。癫痫的发作类型以强直阵挛发作最常见(44.5%),肌阵挛发作(28.3%)居第二位。97.7%的脑瘫合并癫痫患儿有不同程度的智力低下,四肢瘫患儿癫痫发病率最高(61.9%)。 结论 出生低体重、颅内出血患儿,以及四肢瘫合并智力发育落后、脑结构异常者发生癫痫的风险增高,临床应给予重视。

Objective To investigate the clinical characteristics and the risk factors of cerebral palsy(CP) complicated with epilepsy. Methods A total of 522 children with CP(92 cases complicated with epilepsy and 430 cases non-complicated with epilepsy) were studied retrospectively,including the high risk factors and iconography.The clinical onset of epilepsy,the type of paralysis and level of mental development were also analyzed in 92 cases complicated with epilepsy. Results The incidence of 522 cases of children with cerebral palsy with epilepsy was 17.6%.The study demonstrated that the risk factors of CP complicated with epilepsy were low birth weight (χ²=6.564,P<0.05)and intracranial hemorrhage(χ²=11.797,P<0.05).There were no statistically significant differences between the two groups in preterm delivery,asphyxia,and pathologic jaundice.The imaging findings showed the encephalomalacia(χ²=5.250,P<0.05) and brain structure deformity (χ²=14.020,P<0.05) were predictive risk factors for epilepsy,while there was no statistically differences between cerebral hypoplasia and ventriculomegaly (P>0.05 ).The most common onset type of epilepsy was tonic-clonic seizures(44.5%),myoclonic seizures in second place(28.3%),followed by focal seizures(15.3%),infantile spasms(10.8%),one patients without typical attack(1.1%).97.7% children with CP complicated with epilepsy had different degrees of mental retardation.The highest incidence of epilepsy was quadriplegia(61.9%). Conclusion Children with low birth weight,intracranial hemorrhage,cerebral palsy with mental retardation and structural brain abnormalities should increase risks for epilepsy,clinical attention should be paid to.