以血糖异常为病因的32例癫痫患者临床分析

Clinical features of epilepsy patients with blood glucose abnormalities as the etiology: An analysis of 32 cases

摘要:

目的 探讨以血糖异常为病因的癫痫病例的临床表现、生化检查结果、影像学特点、脑电图表现、治疗和预后，以提高对该疾病的认识。方法 回顾性分析2020年1月至2023年12月在郑州大学第五附属医院及郑州大学第一附属医院就诊的癫痫患者资料，明确病因与血糖相关的患者资料并进行随访。结果 获得32例患者资料。其中，男性15例，女性17例；中位年龄为67岁。血清同型半胱氨酸检测值为9.1～76.4 μmol/L，中位数为17.9 μmol/L。糖化血红蛋白4.2%～11.4%，中位数为6.3%。脑电图结果显示，单侧及双侧蝶骨、颞部较多尖波、尖慢波（15例），清醒期双侧额、中央、颞部较多为θ波（30例），清醒期各导1.5～2.5 Hz的δ波短–中程同步或非同步发放（5例）。磁共振成像显示，双侧海马T2液体抑制反转恢复序列高信号、单侧或双侧脑室颞角稍大（13例），脑萎缩（20例），脑白质脱髓鞘（28例），未见特异性异常（4例）。随访6个月，除2例患者注射胰岛素依从性差外，其余30例患者癫痫症状均得到控制，预后良好（13例临床无发作，17例发作频率较前减少≥50%，2例发作频率较前减少<50%）。结论 找到病因，针对病因进行治疗后，此类患者癫痫症状大多可以得到控制，预后良好。脑电图示单侧及双侧蝶骨、颞部较多尖波、尖慢波，磁共振成像显示双侧海马T2液体抑制反转恢复序列高信号，可作为血糖异常病因的识别标志。

Abstract:

Objective To investigate the clinical manifestations， laboratory test results， imaging features， electroencephalogram （EEG） findings， treatment， and prognosis of epilepsy patients with the etiology of blood glucose abnormalities， and to improve the understanding of this disease.Methods A retrospective analysis was performed for the data of the patients with epilepsy who attended The Fifth Affiliated Hospital of Zhengzhou University and The First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023. The patients with the etiology associated with blood glucose were identified and followed up.Results The clinical data were collected from 32 patients， among whom there were 15 male patients and 17 female patients， with a median age of 67 years. The level of blood homocysteine ranged from 9.1 to 76.4 μmol/L， with a median of 17.9 μmol/L， and glycated hemoglobin ranged from 4.2% to 11.4%， with a median of 6.3%. EEG findings showed more sharp and slow waves in the unilateral and bilateral sphenoid bones and temporal regions in 15 patients； during wakefulness， 30 patients had more θ waves in the bilateral frontal， central， and temporal regions， while short- and medium-range synchronous or asynchronous distribution of 1.5-2.5 Hz δ wave was observed in 5 patients. Magnetic resonance imaging （MRI） showed that 13 patients had high signal intensity in bilateral hippocampal T2 FLAIR sequences and slightly larger temporal angles in the unilateral or bilateral ventricles， and there were 20 patients with brain atrophy， 28 with demyelination of white matter， and 4 without specific abnormalities. During the 6-month follow-up， except for 2 patients with poor compliance to insulin injection， the other 30 patients achieved the control of epilepsy symptoms and had a good prognosis， among whom 13 patients had no clinical seizures， 17 patients had a reduction in seizure frequency by ≥50%， and 2 patients had a reduction in seizure frequency by <50%.Conclusions Most patients with epilepsy can achieve the control of epilepsy symptoms and a good prognosis after identification of etiology and treatment targeting such etiology. Multiple sharp and slow waves in the unilateral or bilateral sphenoid bones and temporal regions on EEG and high signal intensity in the T2 FLAIR sequence of the bilateral hippocampus on MRI can be used to identify the etiology of blood glucose abnormalities.