| Viral encephalitis is a kind of common infectious diseases in thecentral nervous system, which mostly acute onset, and clinicallycharacterized by fever, headache, convulsions, consciousness disorder,limb paralysis and meningeal irritation, etc. Viral encephalitis with onsetof epilepsy is the most common one, more common in part to a secondarycomprehensive attack. Golden standard for diagnose is to find the virusantigen or specific antibody from cerebrospinal fluid, and find virusduring brain tissue biopsy. But the positive rate of CSF virus antibody islow, the destructiveness of brain tissue biopsy is great, so it hasn’t beenaccepted by all the patients and their families. Current clinical diagnosismainly depends on imaging, electroencephalogram, lumbar puncturecerebrospinal fluid in routine biochemical changes, etc. The prognosis ofviral encephalitis is closely related to whether its treatment is in a timeand the severity of the illness.Objective:Based on analysis of the clinical features of72patients of viralencephalitis with onset of epilepsy, mainly through imaging, the changeof electroencephalogram, cerebrospinal fluid, the value of application inearly diagnosis of the disease, to provide help for clinical diagnosis andtreatment.Method:Choosing72patients who were diagnosed of viral encephalitis withonset of epilepsy as the research object in jilin university from2011to2014, Bethune first hospital, among those48cases were men, aged16-79, and the average age was37.8;24cases were women, aged16-69, theaverage age was43.3.54cases (75%) had precursor infection. Throughthe data statistics and analysis of the clinical characteristics including age,sex, disease onset form, signs, intracranial pressure, routine biochemistry,and cytology, virus detection, imaging(cranial CT and head MRI) andelectroencephalography changes, as well as through the data statistics andanalysis of the treatment.Result:Among the72patients of viral encephalitis with onset of epilepsy,48are men while24are women,its ratio is2:1, there are63of them whobelong to partially secondary comprehensive seizure(87.5%),2of thembelong to complex partial seizure(2.8%),2of them belong to simplepartial seizure (2.8%), and5of them belong to comprehensive seizure（6.9%）,all start with acute onset, and may be accompanied by precursorinfection, including fever48cases (66.7%), abdominal pain and diarrheafour people (5.6%),2oral herpes (2.8%). Peripheral blood abnormal68people (94.4%),4people leukocyte increased (5.8.8%), eight peopleneutral grain increased (11.8%) and46people (67.6%) increased both ofthem two. Lumbar puncture cranial pressure measurement,45peoplepressure increased (62.5%), including pressure between (180~300)mmH2O39people (86.7%), more than300mmH2O6people(13.3%).Cerebrospinal fluid routine biochemistry abnormal59people(81.9%), including59people’s leukocyte increased (100%),45people’s protein increased (76.3%),7people’s glucose was abnormal(13.5%), including1slightly decreased (14.3%) and11people’s chloridedecreased (15.3%). In the cytological examination,57people (96.6%)given priority to lymphocytes, monocytes increase.30people conductedthe virus antibody of blood and cerebrospinal fluid, among which six of them were abnormal (20%).24people conducted head CT, including2people abnormal (8.3%).58patients conducted head MRI, among which33(56.9%) of them were found abnormal signal, mainly involving thelesion site frontal lobe, temporal lobe, hippocampus, insula, basal ganglia,thalamus, the brain stem, etc., can be on single side or double side.61patients conducted electroencephalogram examination,11conductedlong-time electroencephalogram, and all showed abnormal brain waves.50people conducted video electroencephalogram, and44of them showedabnormal brain waves. According to evaluation criteria[24-25], among these44patients,3of them were on the edge,21people were slightly abnormal,15were moderately abnormal,5people were severely abnormal.11conducted long-time electroencephalogram,7patients originated fromfrontal region,4patients originated from temporal region, sharp wave andsharp slow wave could be seen, among them,1is detected statusepilepticus, the other10could consider to be partial epilepsy. All the72patients are given antiviral treatment,20patients （27.7%） stillaccompanied by epileptic seizures when in hospital,13patients (65%)take orally oxcarbazepine,3patients (15%) take orally Levetiracetam,4patients (20%) take Depakine oral liquid. Among the72patients,15ofthem (20.8%) showed status epilepticus,10of them get relief after treatedwith Luminal and Diazepam;5patients were pumped with Depakine,3oftheir seizures could be controlled, and the sustained epileptic seizuresstatus of2of them can be controlled after treated combined with propofolsedation.20patients who take oral antiepileptic drugs are offeredfollow-up visit after they discharge from hospital,13patients succeed ingetting the follow-up visit,9patients who take orally oxcarbazepine,8ofthem are under control; seizures are under control for each two patientswho take Levetiracetam and Depakine oral liquid. Conclusion:Viral encephalitis with onset of epilepsy can be found in any age,disease outbreak is from20to50years old.87.5%of patients withepileptic seizure form of partially secondary comprehensive seizure. Forpatients who have viral encephalitis with onset of epilepsy,72.2%of themnever suffer epileptic seizure after antiviral treatment,27.8%of themshould be added antiepileptic drug therapy based on antiviral treatmenttherapy. |
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