ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2021, Vol. 13 ›› Issue (1): 36-.

• 临床研究 • 上一篇    下一篇

丙戊酸钠控制脑性瘫痪合并临床下癫痫样放电疗效观察

张端秀，蔡慧强，胡恕香   

  1. 361009 福建 厦门，厦门市湖里区妇幼保健院儿童保健科（张端秀）；361003 福建 厦门，厦门市妇幼保健院儿童神经康复科（蔡慧强，胡恕香）
  • 出版日期:2021-02-25 发布日期:2021-05-17
  • 通讯作者: 蔡慧强，E-mail：406228762@qq.com
  • 作者简介:张端秀（1986-），女，主治医师，医学硕士。研究方向：小儿神经系统疾病的康复

Effect of sodium valproate in the treatment of children with cerebral palsy complicated by subclinical epileptiform discharge

ZHANG Duanxiu，CAI Huiqiang，HU Shuxiang   

  1. Xiamen Huli District Maternal and Child Health Care Hospital，Xiamen 361009,China
  • Online:2021-02-25 Published:2021-05-17

PDF (PC)

70

摘要： 目的:〖JP2〗探索丙戊酸钠治疗控制脑性瘫痪(简称脑瘫)合并患儿临床下癫痫样放电的临床疗效。
方法:选取2015年2月至2018年2月厦门市妇幼保健院儿童神经康复科收治住院的脑瘫合并临床下癫痫样放电患儿62例为研究对象,随机分为观察组和对照组各31例。所有受试患儿均接受常规的康复综合治疗。观察组在上述治疗的基础上给予丙戊酸钠口服液常规剂量口服用药，丙戊酸钠血药浓度控制在50～100 mg/L，服药疗程6个月，对照组未用药。在实验周期内，各组根据有无临床癫痫发作，分为有临床发作和无临床发作两类。患儿在服药6个月后复查视频脑电图，观察癫痫样放电控制情况，根据脑电图复查结果分为:癫痫样放电消失、好转、无变化三类。采用粗大运动功能评估评判患儿运动功能改善的情况。
结果:在随访周期内，观察组脱落1例，对照组脱落2例。观察组伴有临床癫痫发作6例，明显少于对照组13例，差异有统计学意义（P<0.05）。用药后复查脑电图结果提示在控制脑瘫患儿合并临床下癫痫样放电方面，观察组有效率为83.33%（25/30），显著高于对照组34.48%（10/29），差异有统计学意义（P<0.05）。治疗组患儿口服丙戊酸钠对于提高患儿运动功能的情况明显优于对照组，差异有统计学意义（P<0.05）。
结论:伴有临床下癫痫样放电的脑瘫患儿，长期口服丙戊酸钠能有效控制或减少临床下癫痫样放电的发生，并降低临床癫痫发作的概率，且能改善患儿运动功能，提高康复治疗效果

关键词: 脑性瘫痪, 临床下癫痫样放电, 丙戊酸钠, 儿童

Abstract: Objective:To explore the clinical effect of sodium valproate in the treatment of cerebral palsy combined with subclinical epileptiform discharge.
Methods:A total of 62 cases of cerebral palsy with subclinical epileptiform discharge were randomly divided into two groups，31 cases in each group. All the children received routine comprehensive rehabilitation treatment. On the basis of the above treatment，the observation group was given 20-40 mg/(kg·d) of sodium valproate oral solution，the blood concentration of which was controlled at 50-100 mg/L，and the course of treatment was 6 months. The control group did not use drugs. During the experimental period，each group was divided into two types according to whether there was clinical seizure or not. After six months of treatment, video EEG was examined to observe the control of epileptiform discharge. According to the results of EEG,the children with epileptiform discharge were divided into three categories: disappearance，improvement and no change. GMFM was used to observe the improvement of motor function.
Results:During the follow-up period, one case in observation group and two cases in control group were lost. Six cases in observation group were complicated by clinical epileptic seizure, obviously fewer than the control group(13 cases), the difference being statistically significant(P<0.05). After treatment, the re-examination of EEG showed that the effective rate in observation group was 83.33%(25/30) for controlling subclinical epileptiform discharge in children with cerebral palsy, significantly higher than that in control group(34.48%, 10/29)（P<0.05）. Oral administration of sodium valproate in the observation group could improve the motion function more significantly, and there was statistical difference(P<0.05).
Conclusion:Long term oral administration of valproate can effectively control or reduce the occurrence of epileptiform discharge and reduce the probability of clinical seizure in children with cerebral palsy who have subclinical epileptiform discharge. It can improve the motor function of children and improve the effect of rehabilitation treatment.

Key words: Cerebral palsy, Subclinical epileptiform discharges, Sodium valproate, Child