目的:观察四药联合治疗婴儿痉挛的疗效,为婴儿痉挛这一难治性癫痫寻求更有效的治疗方法。方法:采用开放、前瞻性研究,对2007年11月～2009年12月新诊断的51例婴儿痉挛患儿采用激素(ACTH+强的松)、托吡酯、丙种球蛋白及维生素B6联合用药。发作完全控制后1天行动态脑电图复查,以观察高峰失律和其他痫样放电情况。并记录不良事件,监测生命征、电解质、血常规、肝、肾功能。结果:51例患儿中完全缓解46例(90.2%),有效2例(3.9%),无效3例(5.9%),总有效率94.1%。症状性婴儿痉挛39例中完全缓解36例(92.3%),有效1例(2.6%),无效2例(5.1%),总有效率94.9%。隐源性婴儿痉挛12例中完全缓解10例(83.3%),有效1例(8.3%),无效1例(8.3%),总有效率91.7%。51例患儿中治疗有效48例,起效时间最快者1天,最慢者23天,其中1～7天起效者39例,8天以上者9例,平均(6.0±4.3)天。46例完全缓解的婴儿痉挛患儿于缓解后1天复查动态脑电图,结果显示45例高峰失律消失,完全正常32例,15例可见散发尖波或尖慢波,1例仍有高峰失律。完全缓解的46例患儿中有3例复发,该3例均为症状性婴儿痉挛,复发时间在完全缓解后2～22个月,其中1例应用ACTH后再次完全缓解;另外2例放弃治疗,其中1例为完全缓解后动态脑电图仍存在高峰失律的先天性巨脑回患儿。结论:四药联合治疗婴儿痉挛的痉挛发作、脑电图改善及完全缓解后的复发情况均优于目前国内外报道,对于婴儿痉挛这一难治性癫痫,笔者推荐作为一种可以尝试的首选治疗方案。 Objective: To observe the curative effect of four drugs in treating infantile spasms and to seek more effective treatment for infantile spasm, a refractory epilepsy. Methods: A total of 51 newly diagnosed infantile spasms from November 2007 to December 2009 were treated with hormones (ACTH + prednisone), topiramate, gamma globulin and vitamin B6 in an open and prospective study. One day after the onset of complete control, a dynamic EEG review was performed to observe peak loss and other epileptiform discharges. Adverse events were recorded and vital signs, electrolytes, blood, liver and kidney function were monitored. Results: Complete response was achieved in 46 of 51 children (90.2%), effective in 2 (3.9%), ineffective in 3 (5.9%), and total effective rate was 94.1%. Symptomatic infantile spasms in 39 cases of complete remission in 36 cases (92.3%), effective in 1 case (2.6%), 2 cases (5.1%), the total effective rate 94.9%. In the 12 cases of cryptogenic infantile spasms, 10 cases (83.3%) were completely relieved, 1 (8.3%) effective, 1 (8.3%) ineffective and the total effective rate was 91.7%. Among the 51 cases, 48 ​​cases were effective, the fastest onset time was 1 day and the slowest was 23 days. Among them, 39 cases were effective in 1 ~ 7 days and 9 cases were more than 8 days with an average of (6.0 ± 4.3) days . 46 cases of complete remission of infantile spasms in children review one day after echocardiography dynamic response, the results showed that 45 cases of loss of peak disappearance, completely normal in 32 cases, 15 cases of spike or sharp wave spikes were seen in 1 case, there are still peaks Lost. Three of the 46 patients who had complete remission relapsed, all of whom were symptomatic infantile spasms. The time to complete relapse was 2 to 22 months after complete remission. One of the 46 patients relapsed completely after ACTH, and the other 2 gave up treatment , Of which 1 case of complete remission of dynamic EEG still exist peak loss of congenital giant brain back to children. Conclusion: The four drugs combined treatment of infantile spasm spasm, EEG improvement and complete remission of recurrence are better than the current domestic and international reports, for infantile spasms of this refractory epilepsy, I recommend as a try to try Treatment programs.