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Article(id=1198228663406785156, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0953.2024.0711, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1689609600000, receivedDateStr=2023-07-18, revisedDate=null, revisedDateStr=null, acceptedDate=1716393600000, acceptedDateStr=2024-05-23, onlineDate=1763609575367, onlineDateStr=2025-11-20, pubDate=1730044800000, pubDateStr=2024-10-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763609575367, onlineIssueDateStr=2025-11-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763609575367, creator=13701087609, updateTime=1763609575367, updator=13701087609, issue=Issue{id=1198202427301265552, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='10', pageStart='1099', pageEnd='1220', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763603320193, creator=13701087609, updateTime=1763603941762, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198205034396746241, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198205034396746242, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1144, endPage=1149, ext={EN=ArticleExt(id=1198228663608111750, articleId=1198228663406785156, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical characteristics of children with cerebral palsy complicated with epilepsy, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the clinical characteristics of pediatric patients with cerebral palsy (CP) who also have comorbid epilepsy. Methods A retrospective analysis was conducted on the clinical data of 155 pediatric patients with CP and comorbid epilepsy admitted to the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022. Patients were divided into 4 groups based on CP subtype: spastic diplegia group (n=29), spastic hemiplegia group (n=33), spastic quadriplegia group (n=73), and non-spastic group (n=20). Differences in sex, season of birth, birth weight, gestational age, and the relationship between gestational age and weight were compared among the groups. Additionally, the relationships between perinatal risk factors, MRI classification system (MRICS), gross motor function classification system (GMFCS), and the age of the first onset of epilepsy with respect to CP subtype were analyzed. Results Among the 155 patients, 101 were male and 54 were female. A lower proportion of patients with spastic hemiplegia was observed with a gestational age of 28-31+6 weeks compared with those with spastic diplegia and spastic quadriplegia (P=0.009). The proportion of patients with a history of asphyxia in spastic hemiplegia group was significantly lower than that in the other 3 groups, and the proportion of patients with hypoxic-ischemic encephalopathy (HIE) in spastic hemiplegia group was significantly lower than in that both spastic quadriplegia group and non-spastic group (P<0.05). The proportion of patients in spastic quadriplegia group who had their first seizure at an age of <1 year was significantly higher than that in spastic diplegic group (P=0.041). The spastic diplegia group exhibited a higher percentage of white matter damage compared with the other 3 groups, and had a lower percentage of gray matter damage compared with both spastic hemiplegic group and non-spastic group (P=0.001). The proportion of patients with GMFCS levels Ⅳ－Ⅴ in spastic quadriplegia group was higher than those in the other 3 groups (P<0.001), and the proportion of patients with levels Ⅰ－Ⅲ in spastic hemiplegia group was significantly higher than those in spastic quadriplegia group and non-spastic group (P<0.001). Conclusion Significant differences were observed among pediatric patients with different subtypes of CP and comorbid epilepsy in factors such as gestational age, history of asphyxia, HIE history, age of first seizure, MRICS classification and GMFCS levels.

, correspAuthors=Guo-Hui Niu, authorNote=null, correspAuthorsNote=
E-mail:
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目的 分析脑性瘫痪(简称脑瘫)共患癫痫患儿的临床特点。方法 回顾性分析2019年1月－2022年12月郑州大学第三附属医院收治的155例脑瘫共患癫痫患儿的临床资料，按照脑瘫分型将患儿分为4组：痉挛型双瘫组(n=29)、痉挛型偏瘫组(n=33)、痉挛型四肢瘫组(n=73)及非痉挛型组(n=20)。比较各组患儿性别、出生季节、出生体重、胎龄以及胎龄与体重关系的差异，分析围产期危险因素、头颅MRI分类系统(MRICS)、粗大运动功能分级(GMFCS)、癫痫首次发病年龄等临床资料与脑瘫分型的关系。结果 155例脑瘫共患癫痫患儿中，男101例，女54例。在胎龄28~31+6周的患儿中，痉挛型偏瘫的比例低于痉挛型双瘫及痉挛型四肢瘫(P=0.009)。痉挛型偏瘫组患儿的窒息史比例明显低于其他3组，缺血缺氧性脑病(HIE)比例明显低于痉挛型四肢瘫组及非痉挛型组(P<0.05)。痉挛型四肢瘫组患儿癫痫首次发作年龄<1岁的比例明显高于痉挛型双瘫组(P=0.041)；痉挛型双瘫组患儿白质损伤的比例高于其他3组，而灰质损伤的比例低于痉挛型偏瘫组及非痉挛型组(P=0.001)；痉挛型四肢瘫组患儿GMFCS分级Ⅳ－Ⅴ级的比例高于其他3组(P<0.001)；痉挛型偏瘫组患儿Ⅰ－Ⅲ级比例明显高于痉挛型四肢瘫组及非痉挛型组(P<0.001)。结论 在脑瘫共患癫痫患儿中，脑瘫分型的患儿在胎龄、窒息史、HIE史、癫痫首次发作年龄、MRICS分类及GMFCS分级方面存在差异。

, correspAuthors=牛国辉, authorNote=null, correspAuthorsNote=
牛国辉，E-mail：
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谢加阳，硕士研究生，主要从事小儿神经系统疾病诊断与治疗方面的研究

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谢加阳，硕士研究生，主要从事小儿神经系统疾病诊断与治疗方面的研究

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谢加阳，硕士研究生，主要从事小儿神经系统疾病诊断与治疗方面的研究

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Int J Rehabil Res, 2021, 44(1): 69-76., articleTitle=Robotic-assisted locomotor treadmill therapy does not change gait pattern in children with cerebral palsy, refAbstract=null), Reference(id=1198319041929642679, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, doi=null, pmid=null, pmcid=null, year=2019, volume=37, issue=11, pageStart=812, pageEnd=815, url=null, language=null, rfNumber=28, rfOrder=27, authorNames=姜永生, 宋婷婷, 张小鸽, journalName=临床儿科杂志, refType=null, unstructuredReference=姜永生, 宋婷婷, 张小鸽, 等. 345例儿童癫痫和癫痫综合征发作类型临床分析[J]. 临床儿科杂志, 2019, 37(11): 812-815., articleTitle=345例儿童癫痫和癫痫综合征发作类型临床分析, refAbstract=null)], funds=[Fund(id=1198319037081027120, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, awardId=ZDSFY-2018-JYB-10, language=EN, fundingSource=Institute of Hospital Management, National Health and Family Planning Commission(ZDSFY-2018-JYB-10), fundOrder=null, country=null), Fund(id=1198319037211050547, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, awardId=ZDSFY-2018-JYB-10, language=CN, fundingSource=国家卫生计生委医院管理研究所(ZDSFY-2018-JYB-10), fundOrder=null, country=null), Fund(id=1198319037320102454, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, awardId=SBGJ2018047, language=EN, fundingSource=Joint Construction Project of Henan Province in Medical Science and Technology Research(SBGJ2018047), fundOrder=null, country=null), Fund(id=1198319037504651835, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, awardId=SBGJ2018047, language=CN, fundingSource=河南省医学科技攻关省部共建项目(SBGJ2018047), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1198319029724217623, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, xref=null, ext=[AuthorCompanyExt(id=1198319029732606231, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, companyId=1198319029724217623, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Child Rehabilitation, the Third Affiliated Hospital of Zhengzhou University/Key Laboratory of Pediatric Brain Injury of Henan Province/Zhengzhou Key Laboratory for Prevention and Treatment of Childhood Cerebral Palsy, Zhengzhou, Henan 450052, China), AuthorCompanyExt(id=1198319029740994840, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, companyId=1198319029724217623, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=郑州大学第三附属医院儿童康复科/河南省小儿脑损伤重点实验室/郑州市儿童脑瘫防治重点实验室，河南郑州 450052)])], figs=[ArticleFig(id=1198319035197784593, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=EN, label=Tab.1, caption=

Comparison of general data of 4 groups of children with cerebral palsy and comorbid epilepsy [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
性别4.3680.224
男101(65.2)11(55.0)22(75.9)50(68.5)18(54.5)
女54(34.8)9(45.0)7(24.1)23(31.5)15(45.5)
出生季节15.5090.078
春44(28.4)6(30.0)14(48.3)17(23.3)7(21.2)
夏39(25.2)2(10.0)7(24.1)21(28.8)9(27.3)
秋38(24.5)9(45.0)5(17.2)15(20.5)9(27.3)
冬34(21.9)3(15.0)3(10.3)20(27.4)8(24.2)
胎龄(周)0.009*
28~31+623(14.8)1(5.0)6(20.7)15(20.5)1(3.0)(1)(2)
32~36+628(18.1)3(15.0)8(27.6)15(20.5)2(6.1)
≥37104(67.1)16(80.0)15(51.7)43(58.9)30(90.9)
出生体重(g)0.036*
<150014(9.0)1(5.0)3(10.3)9(12.3)1(3.0)
1500~250034(21.9)1(5.0)10(34.5)19(26.0)4(12.1)
≥2500107(69.0)18(90.0)16(55.2)45(61.6)28(84.8)
胎龄与体重关系0.925*
大于胎龄儿12(7.7)2(10.0)1(3.4)6(8.2)3(9.1)
适于胎龄儿118(76.1)16(80.0)22(75.9)56(76.7)24(72.7)
小于胎龄儿25(16.1)2(10.0)6(20.7)11(15.1)6(18.2)
), ArticleFig(id=1198319035315225111, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=CN, label=表1, caption=

各组脑瘫共患癫痫患儿一般资料比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
性别4.3680.224
男101(65.2)11(55.0)22(75.9)50(68.5)18(54.5)
女54(34.8)9(45.0)7(24.1)23(31.5)15(45.5)
出生季节15.5090.078
春44(28.4)6(30.0)14(48.3)17(23.3)7(21.2)
夏39(25.2)2(10.0)7(24.1)21(28.8)9(27.3)
秋38(24.5)9(45.0)5(17.2)15(20.5)9(27.3)
冬34(21.9)3(15.0)3(10.3)20(27.4)8(24.2)
胎龄(周)0.009*
28~31+623(14.8)1(5.0)6(20.7)15(20.5)1(3.0)(1)(2)
32~36+628(18.1)3(15.0)8(27.6)15(20.5)2(6.1)
≥37104(67.1)16(80.0)15(51.7)43(58.9)30(90.9)
出生体重(g)0.036*
<150014(9.0)1(5.0)3(10.3)9(12.3)1(3.0)
1500~250034(21.9)1(5.0)10(34.5)19(26.0)4(12.1)
≥2500107(69.0)18(90.0)16(55.2)45(61.6)28(84.8)
胎龄与体重关系0.925*
大于胎龄儿12(7.7)2(10.0)1(3.4)6(8.2)3(9.1)
适于胎龄儿118(76.1)16(80.0)22(75.9)56(76.7)24(72.7)
小于胎龄儿25(16.1)2(10.0)6(20.7)11(15.1)6(18.2)
), ArticleFig(id=1198319035411694111, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=EN, label=Tab.2, caption=

Comparison of perinatal risk factors in 4 groups of children with cerebral palsy and comorbid with epilepsy [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
阴道分娩65(41.9)9(45.0)12(41.4)28(38.4)16(48.5)1.0460.790
高危妊娠119(76.8)15(75.0)22(75.9)60(82.2)22(66.7)3.1410.370
窒息史65(41.9)9(45.0)15(55.2)37(50.7)3(9.1)(1)(2)(3)19.079<0.001
HIE23(14.8)4(20.0)2(6.9)17(23.3)0(1)(3)0.030*
羊水异常48(31.0)6(30.5)11(37.9)25(34.2)6(18.2)3.5570.313
脐带异常28(18.1)3(15.0)5(17.2)16(21.9)4(12.1)1.6600.646
胎盘异常13(8.4)4(20.0)1(3.4)7(9.6)1(3.0)0.145*
病理性黄疸35(22.6)3(15.0)6(20.7)21(28.8)5(15.2)3.3570.340
双胎及多胎妊娠11(7.1)1(5.0)2(6.9)8(11.0)00.213*
妊娠并发症26(16.8)4(20.0)2(6.9)16(21.9)4(12.1)0.252*
低血糖9(5.8)04(13.8)5(6.8)00.080*
先天性畸形21(13.5)04(13.8)14(19.2)3(9.1)0.110*
宫内窘迫21(13.5)3(15.0)2(6.9)14(19.2)2(6.1)0.217*
脑出血19(12.3)4(20.0)4(13.8)8(11.0)3(9.1)0.633*
), ArticleFig(id=1198319035571077666, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=CN, label=表2, caption=

各组脑瘫共患癫痫患儿围产期危险因素比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
阴道分娩65(41.9)9(45.0)12(41.4)28(38.4)16(48.5)1.0460.790
高危妊娠119(76.8)15(75.0)22(75.9)60(82.2)22(66.7)3.1410.370
窒息史65(41.9)9(45.0)15(55.2)37(50.7)3(9.1)(1)(2)(3)19.079<0.001
HIE23(14.8)4(20.0)2(6.9)17(23.3)0(1)(3)0.030*
羊水异常48(31.0)6(30.5)11(37.9)25(34.2)6(18.2)3.5570.313
脐带异常28(18.1)3(15.0)5(17.2)16(21.9)4(12.1)1.6600.646
胎盘异常13(8.4)4(20.0)1(3.4)7(9.6)1(3.0)0.145*
病理性黄疸35(22.6)3(15.0)6(20.7)21(28.8)5(15.2)3.3570.340
双胎及多胎妊娠11(7.1)1(5.0)2(6.9)8(11.0)00.213*
妊娠并发症26(16.8)4(20.0)2(6.9)16(21.9)4(12.1)0.252*
低血糖9(5.8)04(13.8)5(6.8)00.080*
先天性畸形21(13.5)04(13.8)14(19.2)3(9.1)0.110*
宫内窘迫21(13.5)3(15.0)2(6.9)14(19.2)2(6.1)0.217*
脑出血19(12.3)4(20.0)4(13.8)8(11.0)3(9.1)0.633*
), ArticleFig(id=1198319035696906789, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=EN, label=Tab.3, caption=

Comparison of the clinical data of 4 groups of children with cerebral palsy and comorbid epilepsy [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
临床资料合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
MRICS分类0.001*
发育畸形19(12.3)02(6.9)9(12.3)8(24.2)
白质损伤64(41.3)5(25.0)21(72.4)(1)30(41.1) (2)8(24.2) (2)
灰质损伤43(27.7)8(40.0)2(6.9)(1)20(27.4) (2)13(39.4) (2)
混杂/无法分类18(11.6)5(25.0)1(3.4)8(11.0)4(12.1)
正常11(7.1)2(10.0)3(10.3)6(8.2)0
GMFCS分级50.514<0.001
Ⅰ－Ⅲ级82(52.9)12(60.0)21(72.4)18(24.7)(1)(2)31(93.9)(1)(2)(3)
Ⅳ－Ⅴ级73(47.1)8(40.0)8(27.6)55(75.3)(1)(2)2(6.1)(3)
癫痫发病年龄13.0580.041
<1岁69(44.5)9(45.0)7(24.1)41(56.2)(2)12(36.4)
1~3岁51(32.9)5(25.0)12(41.4)23(31.5)11(33.3)
>3岁35(22.6)6(30.0)10(34.5)9(12.3)10(30.3)
癫痫病因0.097*
结构性140(90.3)17(85.0)25(86.2)65(89.0)33(100.0)
非结构性15(9.7)3(15.0)4(13.8)8(11.0)0
癫痫发作起始0.617*
局灶性起始100(64.5)12(60.0)21(72.4)47(64.4)20(60.6)
全面性起始29(18.7)2(10.0)4(13.8)16(21.9)7(21.1)
起始不明26(16.8)6(30.0)4(13.8)10(13.7)6(18.2)
癫痫综合征0.856*
婴儿痉挛症15(71.4)2(13.3)2(13.3)8(53.3)3(20.0)
CSWS3(14.3)01(33.3)1(33.3)1(33.3)
LGS3(14.3)1(33.3)02(66.6)0
脑电分类0.468*
非特异性异常8(5.2)2(10.0)2(6.9)3(4.1)1(3.0)
痫样放电136(87.7)17(85.0)26(89.7)66(90.4)27(81.8)
正常11(7.1)1(5.0)1(3.4)4(5.5)5(15.2)
), ArticleFig(id=1198319035835318825, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198228663406785156, language=CN, label=表3, caption=

各组脑瘫共患癫痫患儿临床资料比较[例(%)]

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临床资料合计非痉挛型组(n=20)痉挛型双瘫组(n=29)痉挛型四肢瘫组(n=73)痉挛型偏瘫组(n=33)χ2P
MRICS分类0.001*
发育畸形19(12.3)02(6.9)9(12.3)8(24.2)
白质损伤64(41.3)5(25.0)21(72.4)(1)30(41.1) (2)8(24.2) (2)
灰质损伤43(27.7)8(40.0)2(6.9)(1)20(27.4) (2)13(39.4) (2)
混杂/无法分类18(11.6)5(25.0)1(3.4)8(11.0)4(12.1)
正常11(7.1)2(10.0)3(10.3)6(8.2)0
GMFCS分级50.514<0.001
Ⅰ－Ⅲ级82(52.9)12(60.0)21(72.4)18(24.7)(1)(2)31(93.9)(1)(2)(3)
Ⅳ－Ⅴ级73(47.1)8(40.0)8(27.6)55(75.3)(1)(2)2(6.1)(3)
癫痫发病年龄13.0580.041
<1岁69(44.5)9(45.0)7(24.1)41(56.2)(2)12(36.4)
1~3岁51(32.9)5(25.0)12(41.4)23(31.5)11(33.3)
>3岁35(22.6)6(30.0)10(34.5)9(12.3)10(30.3)
癫痫病因0.097*
结构性140(90.3)17(85.0)25(86.2)65(89.0)33(100.0)
非结构性15(9.7)3(15.0)4(13.8)8(11.0)0
癫痫发作起始0.617*
局灶性起始100(64.5)12(60.0)21(72.4)47(64.4)20(60.6)
全面性起始29(18.7)2(10.0)4(13.8)16(21.9)7(21.1)
起始不明26(16.8)6(30.0)4(13.8)10(13.7)6(18.2)
癫痫综合征0.856*
婴儿痉挛症15(71.4)2(13.3)2(13.3)8(53.3)3(20.0)
CSWS3(14.3)01(33.3)1(33.3)1(33.3)
LGS3(14.3)1(33.3)02(66.6)0
脑电分类0.468*
非特异性异常8(5.2)2(10.0)2(6.9)3(4.1)1(3.0)
痫样放电136(87.7)17(85.0)26(89.7)66(90.4)27(81.8)
正常11(7.1)1(5.0)1(3.4)4(5.5)5(15.2)
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脑瘫共患癫痫患儿的临床特点分析
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谢加阳 , 牛国辉 * , 朱登纳 , 王军 , 刘红星 , 王鑫 , 李停停 , 张萌萌
解放军医学杂志 | 临床研究 2024,49(10): 1144-1149
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解放军医学杂志 | 临床研究 2024, 49(10): 1144-1149
脑瘫共患癫痫患儿的临床特点分析
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谢加阳, 牛国辉* , 朱登纳, 王军, 刘红星, 王鑫, 李停停, 张萌萌
作者信息
  • 郑州大学第三附属医院儿童康复科/河南省小儿脑损伤重点实验室/郑州市儿童脑瘫防治重点实验室，河南郑州 450052

    • 谢加阳，硕士研究生，主要从事小儿神经系统疾病诊断与治疗方面的研究

通讯作者:

牛国辉，E-mail：
Clinical characteristics of children with cerebral palsy complicated with epilepsy
Jia-Yang Xie, Guo-Hui Niu* , Deng-Na Zhu, Jun Wang, Hong-Xing Liu, Xin Wang, Ting-Ting Li, Meng-Meng Zhang
Affiliations
  • Department of Child Rehabilitation, the Third Affiliated Hospital of Zhengzhou University/Key Laboratory of Pediatric Brain Injury of Henan Province/Zhengzhou Key Laboratory for Prevention and Treatment of Childhood Cerebral Palsy, Zhengzhou, Henan 450052, China
出版时间: 2024-10-28 doi: 10.11855/j.issn.0577-7402.0953.2024.0711
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摘要
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目的 分析脑性瘫痪(简称脑瘫)共患癫痫患儿的临床特点。方法 回顾性分析2019年1月－2022年12月郑州大学第三附属医院收治的155例脑瘫共患癫痫患儿的临床资料，按照脑瘫分型将患儿分为4组：痉挛型双瘫组(n=29)、痉挛型偏瘫组(n=33)、痉挛型四肢瘫组(n=73)及非痉挛型组(n=20)。比较各组患儿性别、出生季节、出生体重、胎龄以及胎龄与体重关系的差异，分析围产期危险因素、头颅MRI分类系统(MRICS)、粗大运动功能分级(GMFCS)、癫痫首次发病年龄等临床资料与脑瘫分型的关系。结果 155例脑瘫共患癫痫患儿中，男101例，女54例。在胎龄28~31+6周的患儿中，痉挛型偏瘫的比例低于痉挛型双瘫及痉挛型四肢瘫(P=0.009)。痉挛型偏瘫组患儿的窒息史比例明显低于其他3组，缺血缺氧性脑病(HIE)比例明显低于痉挛型四肢瘫组及非痉挛型组(P<0.05)。痉挛型四肢瘫组患儿癫痫首次发作年龄<1岁的比例明显高于痉挛型双瘫组(P=0.041)；痉挛型双瘫组患儿白质损伤的比例高于其他3组，而灰质损伤的比例低于痉挛型偏瘫组及非痉挛型组(P=0.001)；痉挛型四肢瘫组患儿GMFCS分级Ⅳ－Ⅴ级的比例高于其他3组(P<0.001)；痉挛型偏瘫组患儿Ⅰ－Ⅲ级比例明显高于痉挛型四肢瘫组及非痉挛型组(P<0.001)。结论 在脑瘫共患癫痫患儿中，脑瘫分型的患儿在胎龄、窒息史、HIE史、癫痫首次发作年龄、MRICS分类及GMFCS分级方面存在差异。

脑性瘫痪  /  癫痫  /  粗大运动功能分级系统  /  临床分型  /  脑电图

Objective To explore the clinical characteristics of pediatric patients with cerebral palsy (CP) who also have comorbid epilepsy. Methods A retrospective analysis was conducted on the clinical data of 155 pediatric patients with CP and comorbid epilepsy admitted to the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022. Patients were divided into 4 groups based on CP subtype: spastic diplegia group (n=29), spastic hemiplegia group (n=33), spastic quadriplegia group (n=73), and non-spastic group (n=20). Differences in sex, season of birth, birth weight, gestational age, and the relationship between gestational age and weight were compared among the groups. Additionally, the relationships between perinatal risk factors, MRI classification system (MRICS), gross motor function classification system (GMFCS), and the age of the first onset of epilepsy with respect to CP subtype were analyzed. Results Among the 155 patients, 101 were male and 54 were female. A lower proportion of patients with spastic hemiplegia was observed with a gestational age of 28-31+6 weeks compared with those with spastic diplegia and spastic quadriplegia (P=0.009). The proportion of patients with a history of asphyxia in spastic hemiplegia group was significantly lower than that in the other 3 groups, and the proportion of patients with hypoxic-ischemic encephalopathy (HIE) in spastic hemiplegia group was significantly lower than in that both spastic quadriplegia group and non-spastic group (P<0.05). The proportion of patients in spastic quadriplegia group who had their first seizure at an age of <1 year was significantly higher than that in spastic diplegic group (P=0.041). The spastic diplegia group exhibited a higher percentage of white matter damage compared with the other 3 groups, and had a lower percentage of gray matter damage compared with both spastic hemiplegic group and non-spastic group (P=0.001). The proportion of patients with GMFCS levels Ⅳ－Ⅴ in spastic quadriplegia group was higher than those in the other 3 groups (P<0.001), and the proportion of patients with levels Ⅰ－Ⅲ in spastic hemiplegia group was significantly higher than those in spastic quadriplegia group and non-spastic group (P<0.001). Conclusion Significant differences were observed among pediatric patients with different subtypes of CP and comorbid epilepsy in factors such as gestational age, history of asphyxia, HIE history, age of first seizure, MRICS classification and GMFCS levels.

cerebral palsy  /  epilepsy  /  gross motor function classification system  /  clinical classification  /  electroencephalogram
谢加阳, 牛国辉, 朱登纳, 王军, 刘红星, 王鑫, 李停停, 张萌萌. 脑瘫共患癫痫患儿的临床特点分析. 解放军医学杂志, 2024 , 49 (10) : 1144 -1149 . DOI: 10.11855/j.issn.0577-7402.0953.2024.0711
Jia-Yang Xie, Guo-Hui Niu, Deng-Na Zhu, Jun Wang, Hong-Xing Liu, Xin Wang, Ting-Ting Li, Meng-Meng Zhang. Clinical characteristics of children with cerebral palsy complicated with epilepsy[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (10) : 1144 -1149 . DOI: 10.11855/j.issn.0577-7402.0953.2024.0711
正文
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脑性瘫痪(简称脑瘫)是一组持续存在的中枢性运动及姿势发育障碍、活动受限症候群，为发育中的胎儿或婴幼儿脑部非进行性损伤所致[1]。脑瘫的患病率为1.4‰~3.2‰，中国1~6岁儿童脑瘫患病率为2.46‰[1]。运动功能障碍是脑瘫的核心症状，也常伴有其他共患病，如感觉、知觉、认知、沟通、行为障碍、癫痫及继发性肌肉骨骼障碍[2-3]，其中癫痫是脑瘫患儿常见的共患病之一[4]。
文献报道脑瘫患儿癫痫的发病率各不相同，为15%~90%，多数为35%~41%，主要取决于纳入患儿的脑瘫分型及共患病类型[5-7]。癫痫是影响脑瘫患儿预后及死亡的主要原因之一，因此脑瘫与癫痫的关系仍是临床研究的热点[7-9]。脑瘫共患癫痫通常意味着更严重的运动功能障碍及神经损伤[10]。鉴于目前关于脑瘫共患癫痫的文献报道差异较大，本研究分析了脑瘫共患癫痫患儿的分型与围产期危险因素、头颅MRI分类系统(MRI classification system，MRICS)、粗大运动功能分级(gross motor function classification system，GMFCS)及癫痫首次发病年龄的关系，详细了解脑瘫共患癫痫患儿的临床特点，旨在为其临床精准诊治提供依据。
1 资料与方法
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1.1 研究对象
收集2019年1月－2022年12月在郑州大学第三附属医院神经内科或儿童康复科住院的155例脑瘫合并癫痫患儿的临床资料进行回顾性分析。按照脑瘫分型将患儿分为4组：痉挛型双瘫组(n=29)、痉挛型偏瘫组(n=33)、痉挛型四肢瘫组(n=73)及非痉挛型组(n=20)。纳入标准：(1)符合脑瘫的诊断标准[11]；(2)符合国际抗癫痫联盟2022年修订的癫痫诊断标准[12]；(3)年龄<18岁。排除标准：病历资料不完整，如缺少头颅MRI、脑电图、癫痫发作描述、孕产史等重要临床资料。本研究获郑州大学第三附属医院伦理委员会审批(2022-041-01)。
1.2 研究方法
1.2.1 一般资料收集
通过医院电子病历检索系统收集<18岁患儿的人口学信息及病史资料。(1)基本资料：性别、孕周、出生体重、出生季节等。(2)母孕期及围产期资料：分娩史、高危妊娠史、宫内窘迫、窒息、先天性畸形、多胎、妊娠并发症、羊水异常、脐带异常、胎盘异常、新生儿缺血缺氧性脑病(hypoxic ischemic encephalopathy，HIE)、低血糖史、脑出血史等。其中先天性畸形包括常见的先天性心脏病、疝、脑积水、隐睾、多指、并指、血管瘤等多个系统的发育畸形，因疾病谱复杂、种类繁多且发病率较低，故本文统一描述为先天性畸形；羊水异常包括羊水污染、血性羊水、羊水过多或过少；脐带异常包括脐带扭转或脐带绕颈(>2周)；胎盘异常包括前置胎盘或胎盘早剥[13]。(3)癫痫病史资料：癫痫首次发病年龄、癫痫发作类型、癫痫病因、癫痫综合征情况等。(4)辅助检查：GMFCS评估、视频脑电图、头颅MRI等检查结果。GMFCS分级按照0~2岁、2~4岁、4~6岁、6~12岁、>12岁5个年龄段的粗大运动功能标准，功能从高至低分为Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级共5个等级[11]；统计分析时将Ⅰ－Ⅲ级合并为轻症组，Ⅳ－Ⅴ级合并为重症组。
1.2.2 分类标准
155例患儿就诊时年龄为4.028(1.833，5.500)岁；胎龄为28~42+2周，其中≥42周患儿4例。出生体重为830~4400 g，其中超低出生体重儿(≤1000 g)3例，巨大儿(≥4000 g)6例。为统计需要，将患儿按胎龄分为3组：28~31+6周组、32~36+6周组及≥37周组；按出生体重分为3组：<1500 g组、1500~2500 g组及≥2500 g组；依据中国不同性别胎龄新生儿出生体重曲线，按照世界卫生组织的定义[14]，以同胎龄同性别出生体重的P10、P90为分界标准，将患儿分为3组：大于胎龄儿组、适于胎龄儿组及小于胎龄儿组。
采用欧洲脑瘫监测组织2017年脑瘫患儿头颅MRICS分类标准[15]，将患儿头颅MRI结果分为A类(脑发育不良)、B类(白质损伤为主)、C类(灰质损伤为主)、D类(杂项或其他分类不包括的异常)、E类(无明显异常)。由儿童康复科及影像科高年资医师分别判读患儿头颅MRI结果，如有争议则请第三位高年资康复科或影像科医师共同讨论后得出结论，如头颅MRI有多种异常分类，则结合临床资料(脑瘫分型、围产期因素等)选取最可能导致脑瘫的分类。
癫痫发作起源及分类：由于临床文字资料记录癫痫发作详细类型存在局限性，故采用国际抗癫痫联盟2022年修订的癫痫发作类型分类[12]中的基本版，结合本研究中患儿数量及统计需要，将患儿按照癫痫发作起始分为局灶性起始组、全面性起始组及起始不明组，同时根据癫痫首次发作年龄分为<1岁组、1~3岁组及>3岁组。脑电图诊断参考2017版《临床脑电图学》[16]，结合患儿的脑电活动频率、节律、波幅变化，将尖波、棘波、尖慢波、棘慢波、多棘慢波、高度失律等视为痫样放电，背景活动异常、阵发性慢波、纺锤波缺如等视为非特异性异常。
脑瘫的临床分型：按照运动障碍类型及瘫痪部位分为痉挛型四肢瘫、痉挛型双瘫、痉挛型偏瘫、不随意运动型、共济失调型、混合型[11]，由于不随意运动型、共济失调型和混合型3种类型患儿数量少，故分析时统称为非痉挛型。
1.2.3 指标分析
比较不同脑瘫分型的患儿在性别、出生季节、出生体重、胎龄以及胎龄与体重关系方面的差异，分析围产期危险因素、头颅MRICS分类、GMFCS分级、癫痫首次发病年龄等资料与脑瘫分型的关系。
1.3 统计学处理
采用SPSS 21.0软件进行统计分析。根据需要将胎龄、出生体重、癫痫首次发病年龄等计量资料转化为计数资料，以例(%)表示，组间比较采用χ2检验或Fisher精确概率法，进一步两两比较采用Bonferroni法。P<0.05为差异有统计学意义。
2 结果
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2.1 各组一般资料比较
在胎龄28~31+6周的患儿中，痉挛型偏瘫组的比例低于痉挛型双瘫组及痉挛型四肢瘫组(P<0.05)；4组患儿在性别、出生季节及胎龄与体重关系的方面，差异均无统计学意义(P>0.05)。4组患儿出生体重比较差异有统计学差异(P=0.036)，但组间两两比较差异无统计学意义(P>0.05)(表1)。
2.2 患儿围产期危险因素与脑瘫分型的关系
各组阴道分娩、高危妊娠、羊水异常、脐带异常、胎盘异常、病理性黄疸、双胎及多胎妊娠、妊娠并发症、低血糖、先天性畸形、宫内窘迫、脑出血比较差异均无统计学意义(P>0.05)。各组窒息史和HIE差异均有统计学意义(P<0.05)，其中，痉挛型偏瘫组患儿窒息史比例(9.1%)均低于其他3组(55.2%、50.7%、45.0%，P<0.05)，HIE比例(0)低于痉挛型四肢瘫组和非痉挛型组(23.3%、20.0%，P<0.05)(表2)。
2.3 各组患儿的临床资料与脑瘫分型的关系
各组患儿的MRICS分类、GMFCS分级及癫痫发病年龄比较，差异均有统计学意义(P<0.05)。MRICS分类中，痉挛型双瘫患儿的白质损伤比例(72.4%)高于其他P<0.05)。痉挛型四肢瘫组患儿癫痫首次发作年龄多<1岁，且比例(56.2%)高于痉挛型双瘫组患儿(24.1%，P<0.05)。各组癫痫病因、癫痫发作分类、癫痫综合征及脑电分类比较差异均无统计学意义(P>0.05)(表3)。
3 讨论
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脑瘫和癫痫均是儿童常见的神经发育障碍性疾病，癫痫又是脑瘫患儿常见的共患病，临床工作中常可观察到脑瘫共患癫痫患儿的预后较单纯脑瘫/癫痫患儿更差，而既往关于脑瘫共患癫痫患儿的临床研究尚未从脑瘫分型的角度进行分析，且样本量不够大。本研究纳入的155例患儿中，男性占65.3%，与既往文献报道脑瘫共患癫痫患儿的性别比例基本一致[8,17-18]。原因可能是由于雌激素对脑细胞的保护作用[19]、X染色体上的遗传物质变异[20]及大脑早期发育的基因表达不同[21]，导致神经发育障碍性疾病存在性别差异；脑瘫和癫痫是儿童时期最常见的两种神经发育障碍性疾病，本研究和既往研究均发现男性发病率高于女性[22]，也支持以上研究的结论。
本研究的脑瘫共患癫痫患儿中常见的脑瘫类型是痉挛型四肢瘫(47.1%)和痉挛型偏瘫(21.3%)，与Karatoprak等[23]及Abdel Maksoud等[17]的研究结果一致。可能的原因为：共患癫痫的患儿通常神经系统损伤更重，临床上痉挛型四肢瘫的患儿严重程度常较其他患儿重，且癫痫发作本身也可能会对发育中的神经系统造成损害[24]，脑瘫与癫痫相互影响，因而脑瘫共患癫痫患儿中痉挛型四肢瘫更常见。
本研究还发现，脑瘫分型与出生胎龄也有关，痉挛型双瘫与痉挛型四肢瘫的患儿胎龄在28~31+6周的比例明显高于痉挛型偏瘫；痉挛型偏瘫患儿的胎龄多≥37周，与非痉挛型患儿的胎龄分布相似。通常来说，胎龄和出生体重具有明显的相关性，故脑瘫共患癫痫患儿出生体重和脑瘫分型的关系与胎龄和脑瘫分型的关系相似，如痉挛型偏瘫患儿的出生体重<1500 g的比例低于其他类型脑瘫患儿，而出生体重≥2500 g的患儿比例高于其他类型，但二者未表现出明显的统计学差异。
脑瘫共患癫痫患儿的病因复杂，可分为遗传性及非遗传性因素[25]。本研究中非遗传性的围产期危险因素依次为高危妊娠(76.8%)、窒息(41.9%)、羊水异常(31.0%)；Minocha等[26]也发现，窒息是脑瘫共患癫痫常见的危险因素(45.5%)。而与脑瘫分型有关的危险因素为窒息史、HIE。在痉挛型偏瘫患儿中，窒息史的比例远低于其他3类患儿，而HIE史的比例低于痉挛型四肢瘫及非痉挛型患儿；窒息史和HIE史与脑瘫分型的关系相似，这可能与围产期窒息是HIE最常见的病因有关。此外，窒息和HIE造成的脑损伤多以双侧为主，故痉挛型偏瘫患儿中窒息史和HIE的比例较低。
在影像学方面，白质损伤为脑瘫患儿最常见的损伤类型(41.3%)；部分损伤类型与脑瘫分型有关，如痉挛型双瘫的脑瘫共患癫痫患儿中白质损伤的比例(72.4%)明显高于其他3类患儿，而灰质损伤的比例(6.9%)明显低于其他3类患儿。既往研究也提示侧脑室周围白质软化是脑瘫共患癫痫患儿最常见的白质损伤类型，皮质-皮质下病变及基底节/丘脑病变为最常见的灰质病变[24]，这些损伤部位也与常见的脑瘫类型一致。
在脑瘫分型与GMFCS分级的关系上，痉挛型偏瘫的脑瘫共患癫痫患儿中GMFCS分级为Ⅰ－Ⅲ的比例(93.9%)明显高于其他分型，非痉挛型脑瘫共患癫痫患儿中Ⅰ－Ⅲ的比例(60.0%)明显高于痉挛型四肢瘫的患儿(24.7%)；痉挛型四肢瘫的脑瘫共患癫痫患儿中GMFCSⅣ－Ⅴ的比例(75.3%)明显高于其他分型，非痉挛型脑瘫的脑瘫共患癫痫患儿中Ⅳ－Ⅴ的比例(40.0%)高于痉挛型偏瘫的患儿(6.1%)；这与各型患儿颅内损伤的严重程度及部位有关。本研究脑瘫共患癫痫患儿中GMFCS分级Ⅳ－Ⅴ级的比例(47.1%)明显高于Petrarca等[27]报道的单纯脑瘫患儿中Ⅳ－Ⅴ级的比例(29.3%)，考虑与脑瘫合并癫痫患儿的神经系统损伤重于单纯脑瘫患儿有关。
44.5%的癫痫患儿在1岁内发病，77.4%的患儿3岁内发病，明显高于姜永生等[28]报道的42.0%的单纯癫痫患儿在3岁内发病，原因可能是脑瘫共患癫痫的患儿脑损伤较单纯癫痫患儿重，故发病年龄较早。在癫痫发病年龄与脑瘫分型的关系上，痉挛型四肢瘫的脑瘫共患癫痫患儿1岁内首次发作的比例(56.2%)高于其他类型且明显高于痉挛型双瘫的患儿(24.1%)，这也与不同类型脑瘫共患癫痫患儿临床症状的差异相呼应。总之，随着癫痫发病年龄的增加，痉挛型四肢瘫的脑瘫共患癫痫患儿患病率明显低于其他类型患儿，Mert等[5]的研究也支持这一结论。
综上所述，本研究结果显示，脑瘫共患癫痫患儿中男性多于女性，最常见的脑瘫类型为痉挛型四肢瘫，不同脑瘫分型患儿的胎龄、窒息史、HIE史、首次发作年龄、MRICS分类及GMFCS分级存在一定差异。但本研究尚存在不足之处，如属于回顾性研究，样本量不够大且为单中心研究，结果可能具有一定的局限性。因此，未来应进一步行多中心或前瞻性研究以得出更具说服力的结论。
基金
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  • 国家卫生计生委医院管理研究所(ZDSFY-2018-JYB-10)
  • 河南省医学科技攻关省部共建项目(SBGJ2018047)
文献
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参考文献 引证文献
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2024年第49卷第10期
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doi: 10.11855/j.issn.0577-7402.0953.2024.0711
  • 接收时间：2023-07-18
  • 首发时间：2025-11-20
  • 出版时间：2024-10-28
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  • 收稿日期：2023-07-18
  • 录用日期：2024-05-23
基金
Institute of Hospital Management, National Health and Family Planning Commission(ZDSFY-2018-JYB-10)
国家卫生计生委医院管理研究所(ZDSFY-2018-JYB-10)
Joint Construction Project of Henan Province in Medical Science and Technology Research(SBGJ2018047)
河南省医学科技攻关省部共建项目(SBGJ2018047)
作者信息
    郑州大学第三附属医院儿童康复科/河南省小儿脑损伤重点实验室/郑州市儿童脑瘫防治重点实验室，河南郑州 450052

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species		 占总种数比例
Percentage of
total species (%)		 属
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Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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