Clinical Analysis Of Features And Antiepileptic Therapeutic Effects Of Subclinical Epileptiform Discharges In Children With Cerebral Palsy

ObjectivesTo investigate the incidence,clinical features and therapeutic effects of SEDs in children with cerebral palsy.MethodsRetrospective analyse the cases-of453cerebral palsy children hospitalized in the neuro-rehabilitation department of Children’s Hospital of Chongqing Medical University from june2009to february2012. Summarize the clinical features of cerebral palsy children accompanied with SEDs:cerebral palsy type,features of cranial MRI and EEG. Follow up the children had been treated more than6months,compare the improvement of EEG and clinical attack situation before and after treatment,statistical analyse the relationship between therapeutic effects and medication, and medicine type.Results1.The incidence of SEDs and seizures in children with cerebral palsy was16.3%(4/453) and9.9%(45/453) respectively.The incidence of SEDs in cerebral palsy children without seizures was18.1%(74/408).2.In the cerebral palsy children with SEDs,spastic cerebral palsy was the most common type(79.7%);Abnormality rate of cranial MRI was93.2%,mainly to periventricular leukomalacia(64.9%);Multifocal epileptiform discharges was the major pattern on EEG,from more to less, discharge sites were central,frontal,temporal,parietal,occipital and prefrontal region.3.Only62.7%(42/67) of the patients was available to be followed up after6months, Medication adherence rate was70.6%(24/34), insufficient of parents’careness is the main reason.4.The incidence of seizures was11.1%(2/18) in the children without standard treatment.66.7%of the treatment was effective in the children with standard treatment,the main antiepileptic drug we choose was levetiracetam (50%),the efficiency difference of each drug group is obvious,but the difference was not statistically significant.Conclusions1.The indience of epileptiform discharges in cerebral palsy children was23.9%,mainly to SEDs.The incidence of SEDs and seizures in children with cerebral palsy was16.3%and9.9%respectively.The incidence of SEDs in cerebral palsy children without seizures was18.1%.2. In the cerebral palsy children with SEDs,spastic cerebral palsy was the most common type(75%),followed by hypotonic and mixed type,no dyskinetic and ataxic type.Maybe related to two reasons:one is different indiences of different cerebral palsy types and less sample in this research;the other is the correlation between pathogenesis of epilepsy and the brain injury area.3.The abnormality rate of cranial MRI in the cerebral palsy children with SEDs was93.2%,higher than normal cerebral palsy children.Because the main brain injury of the former is PVL,more serious than latter.4.Multifocal epileptiform discharges was the major pattern on EEG in the cerebral palsy children with SEDs,left cerebral hemisphere affected slightly more than right hemisphere,from more to less,discharge sites were central,frontal,temporal,parietal,occipital and prefrontal region successively. SEDs can lead to damages of brain function and structural,different focis cause different cognitive dysfunctions,which could be used to guide the treatment of rehabilitation in clinical work.5.The treatment effective rate of66.7%in the group with standard treatment,suggesting that antiepileptic therapeutic effects is good in the cerebral palsy children with SEDs.6.The incidence of seizures was11.1%in the cerebral palsy children with SEDs without standard treatment,the high incidence proved the necessity of antiepileptic treatment.7.The main antiepileptic drug we choose was levetiracetam,followed by oxcarbazepine,valproic acid,lamotrigine.The efficiency difference of each drug group is obvious,but the difference was not statistically significant.The effect on cognitive function and the use of antiepileptic drugs of SEDs in children with cerebral palsy need more large sample to analyse and discuss.8.From follow-up,we find two problems:the follow-up rate and medication adherence rate is low.Insufficient of parents’ careness is the main reason,medical staff need to strengthen publicity and education of SEDs to children’s parents.