抽动障碍患儿脑电图异常放电的临床意义及价值

Clinical significance and value of abnormal electroencephalographic discharges in children with tic disorders

摘要

目的 对初步诊断为抽动障碍(TD)患儿的视频脑电图(VEEG)进行回顾性分析,探讨脑电图在诊断与鉴别诊断中的意义和价值,以期为TD儿童的诊治提供参考。方法 选取2021年1月—2024年6月在延安市人民医院儿科临床诊断过程中初诊被考虑为TD儿童的258例患儿 VEEG进行回顾分析,对其结果进行分析。结果 258例TD患儿中男童188例(72.9%),女童70例(27.1%),男女比为2.7∶1;初诊考虑TD患儿正常范围VEEG172例(66.7%);界限性VEEG31例(12.0%);异常VEEG55例(21.3%),其中3例最后诊断癫痫。TD患儿VEEG显示醒睡各期均有异常者较多,非特异性异常主要为背景活动慢和不典型尖波、棘波;特异性异常为局灶和/或广泛性痫样放电,其中以局灶性放电居多,且放电部位多样,以中央、顶和/或中后颞区最为多见,少数患儿具有光敏感性。男童与女童间及不同年龄段之间VEEG结果分布差异均无统计学意义(P＞0.05);174例患儿进行耶鲁综合抽动严重程度量表(YGTSS)测评,其中VEEG异常28例(16.1%);男童与女童间及不同年龄段之间YGTSS测评结果差异均无统计学意义(P＞0.05);另外抽动严重程度与VEEG之间亦无显著相关性(P＞0.05)。结论 界限性和异常VEEG在初诊TD患儿较常见,但在性别、年龄以及抽动严重程度间无明显差异。VEEG是初诊TD患儿诊断和鉴别诊断的重要手段。

Abstract

Objective To retrospectively analyze the video electroencephalogram (VEEG) features of children preliminarily diagnosed with tic disorder (TD), and to explore the significance and value of EEG in diagnosis and differential diagnosis, so as to provide a reference for the clinical management of children with TD. Methods A retrospective analysis was performed on VEEG data from 258 children who were preliminarily considered to have TD during clinical diagnosis at the Department of Pediatrics, Yan'an People's Hospital, between January 2021 and June 2024. Results Among the 258 children, there were 188 boys (72.9%) and 70 girls (27.1%), with a male-to-female ratio of 2.7∶1.VEEG results showed 172 cases (66.7%) within normal limits, 31 cases (12.0%) with borderline findings, and 55 cases (21.3%) with abnormalities.Notably, 3 cases were ultimately diagnosed with epilepsy.VEEG abnormalities were frequently observed during both wakefulness and sleep stages.Non-specific abnormalities mainly consisted of slow background activity and atypical sharp or spike waves.Specific abnormalities presented as focal and/or generalized epileptiform discharges, with focal discharges being predominant.The discharge locations varied, most frequently involving the central, parietal, and/or middle-posterior temporal regions.A small number of children exhibited photosensitivity.No statistically significant differences were found in the distribution of VEEG results between genders or across different age groups (P>0.05).Among the 174 children assessed using the Yale Global Tic Severity Scale (YGTSS), 28 (16.1%) presented with VEEG abnormalities.There were no statistically significant differences in YGTSS results regarding gender or age (P>0.05).Furthermore, no significant correlation was found between tic severity and VEEG findings (P>0.05). Conclusions Borderline and abnormal VEEG findings are relatively common in children with a preliminary diagnosis of TD.However, these findings do not differ significantly based on gender, age, or tic severity.VEEG is an important tool for the diagnosis and differential diagnosis of children with suspected TD.

关键词

脑电图 / 异常放电 / 抽动障碍 / 儿童

Key words

electroencephalogram / abnormal discharge / tic disorders / children

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基金资助

延安市科学技术重点研发计划项目(2024LSSFGG-212)