| Research BackgroundEpilepsy is one of the oldest diseases in the world,and its earliest written records can be traced back to 4000 BC[1].It is a chronic brain disease that characterized by complex pathogenesis and recurrent epileptic seizures,which can be caused by a variety of factors,and occurs in all ages,regions and ethnicities.In 2017,International League Against Epilepsy(ILAE)revised the types of seizures and epilepsy[2],which are mainly divided into three types:focal origin,comprehensive origin,and unknown origin.The diagnosis of epilepsy is carried out from seizure type,epilepsy type,epilepsy syndrome,etiology and comorbidity as much as possible[3].Studies show that there are approximately 70 million epilepsy patients worldwide,more than half of them occur in developing countries[4].There are more than 9 million people with epilepsy in our country,of which 6.5 million are active epilepsy[5].Epilepsy has the highest incidence in childhood,and the incidence rate gradually decreases with age as a child[6].As the population ages,the incidence of epilepsy in the elderly is on the rise.Studies show that about 60%of epilepsy originates in childhood,children are the hope of the family and the future of the motherland,if they have epilepsy,not only has a huge negative impact on the family and society,but also may have an impact on children's mental health.Due to the different levels of economic and cultural development in various regions of China,the medical level and medical conditions are different.Henan Province,as a large agricultural and populous province,has relatively backward medical conditions.Epilepsy is one of the intractable and chronic disease.Compared with Beijing and other first-tier cities,there is a gap in medical standards.At present,there is a lack of large sample studies on the related issues of whether the diagnosis and treatment of epilepsy patients are timely and the diagnosis and treatment are reasonable.Department of Pediatric Neurology of the Third Affiliated Hospital of Zhengzhou University has a large number of annual outpatient visits.Patients come from all over the province,so it has strong representative and objective research conditions.Therefore,the analysis of children diagnosed with epilepsy in the Third Affiliated Hospital of Zhengzhou University was used to analyze the overall diagnosis and treatment of children with epilepsy in Henan Province,to understand the current ability of hospitals at all levels to diagnose and treat epilepsy.Research ObjectiveThis study analyzes the clinical characteristics and diagnosis and treatment of children with epilepsy who are referred to our hospital and newly diagnosed by our hospital at the provincial level or below,and explores the diagnosis and treatment of children with epilepsy at all levels of hospitals in Henan Province,analyze the high-risk factors that affect the treatment and treatment effect,and provide reference for the standardized treatment and scientific management of children with epilepsy.Materials and MethodsFrom October 2018 to January 2019,222 children aged 0 to 14 years old who were diagnosed with epilepsy for the first time at the Pediatric Neurology Clinic or Hospital Ward of the Third Affiliated Hospital of Zhengzhou University,filled out the questionnaire epilepsy cases,and collected the gender,age,onset age,etiology,seizure type,birth history,head imaging examination,EEG and treatment etc.The data results were analyzed by using SPSS 22.0 statistical software.Count data was expressed by the number of cases and percentages.Univariate analysis was performed by chi-square test.After univariate analysis,significant influencing factors were used as independent variables,and treatment effects were used as dependent variables.Factors Logistic regression analysis,screened out the factors that affect the treatment effect of children with epilepsy in our hospital and factors that affect the treatment of other hospitals.The test standard was ?=0.05,and P<0.05 showed that the difference was statistically significant.Result1.A total of 222 children with epilepsy were included in this study,132 males and 90 females,the ratio of male to female was 1.47:1.Age of onset:114 cases under 1 year old,32 cases of 1-2 years old,18 cases of 2-3 years old,10 cases of 3-4 years old,8 cases of 4-5 years old,9 cases of 5-6 years old,9 cases of 6-7 years old,7 cases of 7-8 years old,5 cases of 8-9 years old,5 cases of 9-10 years old,2 cases of 10-11years old,1 case of 11-12 years old,2 cases over 12 years old.2.A total of 263 patients were diagnosed outside the hospital,51 were misdiagnosed,and 212 were diagnosed with epilepsy.Of the 212 cases of epilepsy,53 were diagnosed as seizures:28 were generalized,22 were focal,and 3 were unknown.Etiological diagnosis:20 cases were structural,3 cases were hereditary,2 cases were metabolic.A total of 9 cases of epilepsy syndrome were diagnosed and 13 cases with comorbidity.After diagnosis in our hospital,a total of 246 cases of epilepsy were diagnosed and 24 cases were lost to follow-up.A total of 222 effective cases were collected and detailed stratified diagnosis was performed.Type of attack:focal seizure in 114 cases(51.35%),generalized seizure in 97 cases(43.69%),and onset unknown in 11 cases(4.96%).Etiological distribution:49 cases were structural,19 cases were hereditary,11 cases were metabolic,7 cases were infectious,2 cases were immunological,and 134 cases were unknown.62 cases of epilepsy syndrome were diagnosed:23 cases of Benign childhood epilepsy with centrotemporal spikes,(including 2 cases of BECT variant),17 cases of infant spasm(IS),7 cases of early onset of epileptic encephalopathy syndrome type,3 cases of Dravet syndrome,2 cases of Doose syndrome,2 cases of Landau-Kleffner syndrome(LKS),2 cases of Otahara syndrome,2 cases of benign familial infantile epilepsy(BFNE),1 case of Lennox-Gastaut syndrome(LGS),1 case of generalized epilepsy with febrile convulsive additional syndrome(GEFS+),1 case of Epileptic encephalopathy with continuous spike and waves during slow wave sleep(CSWS),1 case of children's absence epilepsy.A total of 73 cases were diagnosed comorbidities,including 55 cases of cognitive impairment,7 cases of tic disorder,4 cases of attention deficit hyperactivity disorder,3 cases of autism spectrum disorder,3 cases of mood disorder and 1 case of sleep disorder.3.Among the 212 children diagnosed with epilepsy in other hospitals,117 were untreated and 95 were treated with medication.The results of single factor chi-square test affecting the treatment and non-treatment of children in other hospitals suggested that there were statistically significant differences in the types of seizures,hospital level of primary diagnosis and family economic conditions(P<0.05).4.Among the 222 children with epilepsy in our hospital,113 were controlled,52 were effective,and 57 were ineffective.The results of single factor chi-square analysis in the two groups suggested that there were statistically significant differences in out-of-hospital treatment,electroencephalogram,epilepsy syndrome,genetic metabolic etiology and clear etiology(P<0.05).Multiple Logistic regression analysis suggested that electroencephalogram and epilepsy syndrome were the high risk factors affecting the treatment effect of epilepsy.5.Among the epilepsy with comorbidity,nineteen children with cognitive disorders received regular family education,two children with tic disorder received oral medication,and one child with autism spectrum disorder received regular psychological therapy.ConclusionMisdiagnosis and mistreatment of epilepsy exist in hospitals below provincial level.The type of seizures,the level of the hospital for initial diagnosis and the family economic conditions affect the treatment of epilepsy.Electroencephalogram and epileptic syndrome are the risk factors that affect the efficacy of antiepileptic drugs.Standardized and hierarchical diagnosis is closely related to the treatment effect of epilepsy. |
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