Application Of CGMS In Infantile Spasms Children With Neonatal Hypoglycemia Encephalopathy

Background and objective:Infantile spasms is a catastrophic epilepsy encephalopathy that occurs in infancy and affects the treatment and prognosis of the disease.Neonatal hypoglycemic encephalopathy can lead to IS,and it is clinically found that such patients have difficulty controlling epilepsy.In order to analyze the effect of hypoglycemia on IS,this study monitored whether children with IS in neonatal hypoglycemic encephalopathy still had persistent hypoglycemia,and based on this,were divided into non-hypoglycemia group and hypoglycemia group.Through comparative analysis,this paper explores the relationship between hypoglycemia and its medication,seizures,treatment and complications in this type of child,and explores the causes of hypoglycemia and brain damage in children by gene analysis,and provides suggestions for prevention and treatment of such children in the future.MethodsThe selected patients were from September 2016 to September 2018 who were admitted to the Pediatric General Hospital of Pediatrics in the neonatal period with hypoglycemia in children with IS.All selected cases were screened in strict accordance with the diagnostic criteria for the classification of epilepsy and epilepsy syndrome recommended by the IS International Association for the Prevention of Epilepsy and the inclusion and exclusion criteria for the study.The enrolled patients were required to have a continuous glucose monitoring system(CGMS)for 3 days.Collect general information about these children,and use a unified questionnaire to investigate whether the mother has diabetes and medication history during pregnancy,whether there is hypoxic asphyxia in the neonatal period,follow-up blood glucose level,time and frequency of first episode,antiepileptic drugs Medication and sputum control.The children were diagnosed with complications during the hospitalization period and the use of anti-epileptic drugs.The selected cases were grouped according to whether the monitored blood glucose results were<3.9 mmol/L(hyperglycemia abnormality)and<2.8 mmol/L(hypoglycemia).The use of antiepileptic drugs,gene mutations,hematuria metabolism,EEq Magnetic Resonance Imaging,development,post-ACTH+MgSO4 control,complications during hospitalization,and discharge at hospital were compared between these two groups.ResultsAccording to the inclusion criteria and exclusion criteria,43 patients were enrolled.Sixteen children with blood glucose monitoring values of?3.9mmol/L were used as the control group,and 27 patients with blood glucose levels<3.9mmol/L in the blood glucose monitoring were used as the experimental group.There was no significant difference in the general data(sex,age at enrollment,age at onset)between the two groups.There was no significant difference in the number of seizures and total seizures between the two groups at admission and at discharge(P>0.05);There was no significant difference in the type and quantity of antiepileptic drugs(P>0.05).Thirty-three children with blood glucose levels of?2.8mmol/L were used as non-hypoglycemia group,and 10 patients with blood glucose level<2.8mmol/L in blood glucose monitoring were used as hypoglycemia group.The treatment-effective hypoglycemia group was 7/10(70.0%)significantly lower than the non-hypoglycemia group(32/33(97.0%))with ACTH+MgSO4(P=0.000).The incidence of complications during the control group and the experimental group were 31.30%and 69.20%,respectively(P=0.016).In the experimental group,3 patients with gene mutations were associated with hyperinsulinemia,and the mutation genes were ABCC8,KCNJ11,SLC16A1,and HNF1A.Conclusion1.This study found that 23.3%of children with IS caused by neonatal hypoglycemic encephalopathy had persistent hypoglycemia(<2.8mmol/L),and the effective rate of using first-line medicine(ACTH+MgSO4)treats IS in children with persistent hypoglycemia is lower(P=0.000),the incidence of hospital complications was higher(P=0.016).Children with neonatal hypoglycemia encephalopathy are at risk of persistent hypoglycemia,which can cause subsequent brain damage to such children.2.In the genetic analysis of children with IS caused by neonatal hypoglycemia encephalopathy,3 children were found to carry mutations related to hyperinsulinemia,suggesting that there may be a genetie eause in neonatal brain injury,and timely screening may be possible.Improve the prognosis of children.