Analysis For Therapeutic Efect Of Benign Epilepsy With Centro-temporal Spikes

Background and ObjectiveBenign childhood epilepsy with centro-temporal spikes is one of the most common partial idiopathic epilepsy syndrome. Its prevalence is1:1000, the cause is unclear, there may be genetic predisposition, Most rolandic seizures occur during non-REM (rapid eye movement) sleep, mainly at sleep onset or just before awakening. On the EEG, typical spikes have a biphasic or triphasic appearance in the central and temporal EEG electrodes, the epileptic spike foci may migrate to the occipital or frontal region as the child grows up. Although the previous studies consider BECT as a benign form of epilepsy occurring in children which usually disappears by the age of16, BECT is not always associated with benign childhood epilepsies, a few patients may present with an atypical evolution of more severe syndromes such as Landau-Kle□ner syndrome, atypical benign partial epilepsy, refactory epilepsy or epilepsy with continuous spike-and-wave during slow sleep, BECTs are not always begnign. Antiepileptic drugs (AEDs) treatment is the main method, but children need to have these drugs for a long time, and AEDs may induce seizure exacerbation or deterioration in cognitive function. It’s necessary to compare the efficacy of different drugs to choose the most ideal drugs.There are three kinds of outome in the antiepileptic treatment of BECTs:1) seizure free and abnormal electroencephalographic (EEG) activity becomes normal,2) seizure free with abnormal EEG activity,3) seizure exacerbation with abnormal EEG activity. The first kind of outcome was thought to be the most universal, the patients tend to to be older; the third was rare, and the patients tend to be younger; the second was between the two kinds above. The normalization of EEG activity is posterior to the control of seizure for two years. The second kind of outcome is found to be comman in clinical treatment. After having taken AEDs for more than two years, there wasn’t any improvement in the abnormal EEG of BECTs. When these children increased the dosage or added other AEDS for1month, the EEG activity would be improved markedly. It has suggested that the wether the EEG is normal is related to the dose of AEDs.ObjectiveTo analyze the clinical features of142patients with BECT and explore its characteristics about the etiology and treatment, so as to choose the most ideal AEDs for children of BECT; The EEG of pre-treatment and post-treatment were compared to invstigate the influence of drug dosage and drug itself on the EGG activity.Methods1、Retrospective analyze the clinicalfeatures of142patients who were diagnosed as BECT, Collect and analyze the detailed information about these patients, such as age, sex, family history, past medical history, febrile seizure history, drug usage neonatal history image findings and prognosis.2、The pre-treatment and post-treatment EEGs of children who were seizure free were compared to analyze the best drug and drug dosage for BECTs.Results1、The average age of BECT was8±4.47years(ranged1-15years), There is a2.2male predominance.106cases were symptomatic or crypogenic epilepties, and36 cases were idiopathic epilepties. Independent samples t test was usde to analyse the year distribution of symptomatic BECT and idiopathic BECT(P=0.01<0.05), there was an difference between the age of symptomatic BECTs and idiopathic BECTs, and the average age of idiopathic BECT was older than symptomatic BECT.2、The three main causes of BECT were family history(17.2%), febrile convulsion history(12.7%) and birth asphyxia(9.2%).3、There were31cases exist abnormal brain imaging among142cases of BECT, and twenty patients had seizure free after antiepileptic therapy, maybe the abnormal brain imaging only had an co-existing relationship with BECT, and it didn’t play an important part in the course of BECT.4、The142cases didn’t have any antiepiletic drugs before the obversation,97patients (44cases had VPA,4cases had TPM,43cases had OXC and6cases had LTG)had seizure control as soon as they had taken the first kind of antiepileptic drugs, they had a high seizure control rate(68.3%), the Chi-square test was used to analyse the statistics,χ2=14.277, P<0.05, there was difference among VPA、OXC and LTG in seizure control rate, the seizure control rate of VPA is higher than that of OXC.5、According to the AEDs all the cases was divided into monotherapy group and combined-therapy group, patients in monotherapy group were treated with one kind of AEDs, and patients in combined-therapy group were treated with more than one kind of AEDs. There was an difference of age between the monotherapy group and combined-therapy group. The percentage of abnormal images in monotherapy is higher than that in combined-therapy group. Among28patients who accepted combined-therapy, there are8children had VPA and LTG,and seven children were free of seizure.6、There are42seizure free patients who had electroencephalogram examination after the antiepileptic therapy among the142cases. They all accepted monotherapy (VPA18cases, OXC2lcases, LTG3cases). According to the results of re-examed EEG,these patients were divided into two groups:noremal group (there was no epileptic discharge in the EEG) and abnormal group (there was epileptic discharge in the EEG). Independent samples t test was used to analyze the relationship between the antiepileptic drugs dosage and the result of EEG(P=0.623), there wasn’t association between the antiepileptic drugs dosage and the result of EEG. Normal EEG in VPA group accounted for72%, while the proportion of normal EEG in the OXC group was28%, we used Chi-square test to analyze it(x2=7.392, P=0.007), The inhibitionrate of EEG epileptiformwave discharges in VPA group was signi ficantly better than the OXC group, the differences were statistically significant (P<0.05).Conclusion1、BECT is genetically autosomal dominant inheritance with age-dependent.2、The main aetiology of BECT is family history; febrile convulsion and birth asphyxia.3、The seizure control rate of OXC is higher than that of VPA.4、The age of monotherapy group was younger than that of combined-therapy group.The patients who had abnormal images may need combined-therapy.VPA combined with LTG was more effeient than other combined therapies.5、The AEDs dosage didn’t have the most significant impact on the inhibition of EEG epileptiform wave discharges..VPA was better than OXC in the inhibitionrate of EEG epileptiformwave discharges.