Objective:The clinical characteristics of children with epilepsy who had polyspike and slow wave complex(PSW)initially monitored by long-term VEEG were analyzed,including the distribution characteristics of PSW,and the effects of different antiseizure medicines(ASMs)on eliminating PSW,in order to better understand the PSW in EEG in children with epilepsy.Method:This study had collected 315 children who were diagnosed epilepsy and present PSW during the first long-term VEEG monitor in outpatient or inpatient in the Department of Pediatric Neurology in the first Hospital of Jilin University from January 2017 to June 2022.Due to the of clinical data,195 cases of them were excluded,and 120 epileptic children were finally enrolled in this study for analysis of clinical characteristics and the distribution characteristics of PSW in EEG,retrospectively.The PSW disappearance in long-term VEEG late follow-up was also analyzed.In addition,the clinical efficacy and improvement of PSW index of epileptic children monotheraputicly treated with valproate(VPA)or levetiracetam(LEV)were summarized,as well as the efficacy of other ASMs were also described.Result:1.Of the 120 epileptic children with PSW,113 cases(94.2%)present single seizure type at the initial stage of epilepsy,including focal seizures in 85(70.8%)cases,typical absence seizures in 14(11.6%)cases,atypical absence seizures in 4(3.3%)cases,myoclonic seizures in 5 cases(4.2%),and eyelid clonus seizures in 2(1.7%)cases.The isolated spastic seizures,focal myoclonic seizures and focal secondary generalized seizures were found in 1(0.8%)case,respectively.Multiple seizures forms present in 7 cases(5.8%).2.Of the 120 epileptic children with PSW,the distribution of brain lobes of PSW in the initial long-term VEEG including: frontal lobe only in 22 cases(18.3%),temporal lobe only in 11 cases(9.2%),parietal lobe only in 10 cases(8.3%),and occipital lobe only in 6 cases(5.0%).The PSW frequency of lobar distribution including: frontal lobe present in 59 cases(49.2%),temporal lobe in 68 cases(56.7%),parietal lobe in 52 cases(43.3%),occipital lobe in 28 cases(23.3%).The PSW present in a single lobe in 49 cases(40.8%),present in 2 lobes in 56 cases(46.7%),and ≥3 lobes in 15 cases(12.5%).3.In the 120 epileptic children with PSW,118 cases(98.3%)could be distinguished awakening stage and sleeping stage in the initial long-term EEG recording.Among them,PSW present during the awakening stage only in just 1 case(0.8%),and present during the sleeping stage only in 18 cases(15.3%),and both the awakening srage and the sleeping stage present PSW in 99 cases(83.9%).There were2 cases(1.7%)failed to record sleep period.There were 77 cases(64.2%)could be clearly distinguished the complete sleep structure(NⅠ、NⅡ、NⅢ、REM stages).The PSW predominantly present during NⅠ stage in 22 cases(28.6%),predominantly present during NⅡ stage in 26 cases(33.8%),during NⅢ stage in 21 cases(27.3%),during awakening stage in 8 cases(10.3%),and no PSW were monitored in the REM stage.There were cases(35.8%)whose complete sleep structure could not be distinguished.4.There was a statistically significant difference refer to the PSW disappearance under single ASM therapy,dual ASMs therapy and three ASMs therapy(H=23.544,P<0.05).The time of PSW disappearance under single ASM therapy was statistically shorter than that of under dual ASMs therapy or three ASMs therapy(P<0.05).There was no significant difference of the PSW disappearance time between cases under dual ASMs therapy and those cases under three ASMs therapy(P > 0.05).5.In the 120 epileptic children with PSW,LEV(78 cases,65.0%)and VPA(41cases,34.2%)were the prefer ASMs.6.Based on the analyses of the efficacy of VPA or LEV single therapy,both VPA and LEV may be effectively in controlling seizures and reducing PSW in epileptic children who present PSW in the initial long-term VEEG.Conclusion:1.Focal seizure is the main seizure type in epileptic children with PSW.2.The PSW mainly implicates the frontal lobe,temporal lobe and parietal lobe in epileptic children,while the occipital lobe is less affected.Moreover,most children(87.5%)involve ≤ 2 brain lobes.3.In epileptic children,PSW mainly appear in both awakening and sleeping stages,and in the sleeping stage PSW present predominantly in NREM I and II stages.There is no PSW present in REM stage.4.In general,in epileptic children with PSW,VPA or LEV monotherapy show effective response in children with epilepsy. |