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患儿女,3岁。于1996年11月以阵发性发笑半年来诊。就诊前半年始,患儿常常无任何诱因突然阵阵高声大笑,伴双眼发直。呼叫不应,有时伴尿失禁,每次发作持续约2～3min 自行缓解,发作后无嗜睡,很快恢复正常,一般每周发作1～2次,就诊前半月发作频繁,每日6～7次,在当地就诊未明确诊断,病后未经任何治疗。患儿为第1胎足月儿,母孕期因前置胎盘在分娩时大出血,患儿出生时无窒息,生长发育同正常同龄儿。体检:一般状态好,心肺、腹部正常,神经系统无异常所见。脑电图未发现异常。脑电图(24h 动态脑电图),清醒状态下未发现异常,临床发作(2次)时及睡眠中显示双侧全部导联阵发性棘慢波。诊断为发笑性癫痫。头部磁共振成像未见异常。给予卡马西平治疗,75mg,每日2次早晚口服(12mg/kg.d)。用药后发笑次数减少,程度减轻,尿失禁消失,继续治疗中。癫痫是小儿神经系统的常见病,多发病,病因复杂,其发作表现形式多种多样,表现为发笑者极少见。本例提示对无诱因阵发性发笑特别是伴眼直者应想到癫痫之可能,应尽早做脑电图检查确诊。
Children with children, 3 years old. In November 1996 to paroxysmal half a year visit. Half a year before the beginning of treatment, children often have no incentive suddenly burst bursts of laughter, with eyes straight. Call should not, sometimes with urinary incontinence, each episode of about 2 ~ 3min to ease themselves, no lethargy after the attack, quickly returned to normal, usually 1 to 2 episodes per week, half and half months before the onset of seizures, daily 6 to 7 Times, not a clear diagnosis in the local treatment, the disease without any treatment. Children with first full-term infants born in the first trimester due to pre-term placenta previa bleeding in childbirth, children without asphyxia at birth, growth and development with normal children of the same age. Physical examination: the general state of good, cardiopulmonary and abdominal normal, no abnormalities seen in the nervous system. EEG was not found abnormalities. EEG (24h dynamic electroencephalogram), no abnormal sober state, clinical seizures (2 times) and during sleep showed all the leads on both sides of spikes and spikes slow wave. Diagnosed with amicable epilepsy. No abnormality of head MRI. Give carbamazepine treatment, 75mg, 2 times a day morning and evening oral (12mg / kg.d). After treatment reduce the number of smiles, reduce the extent of incontinence disappeared, continue treatment. Epilepsy is a common disease of children’s nervous system, frequently-occurring disease, the etiology is complex, the manifestations of a variety of seizures, manifested as a joke are rare. This case prompted paroxysmal amnesia motivated especially with eye contact should think of the possibility of epilepsy, EEG diagnosis should be done as soon as possible.