探讨甲泼尼龙冲击治疗儿童睡眠中癫痫性电持续状态(ESES)的临床疗效。

选择2008年1月至2013年1月于山东省鄄城县第二人民医院收治的56例ESES儿童为研究对象。将其按照数字表随机分组法分为实验组(n = 28)和对照组(n = 28)。给予对照组患儿常规抗癫痫药物治疗，实验组在对照组治疗基础上给予甲泼尼龙15 mg/(kg ? d)，治疗3 d后停药4d，连续治疗3周，之后给予甲泼尼龙1.5~2.0 mg/(kg ? d)晨起顿服给药方式，4周后逐渐减量，根据患儿情况总疗程为4~6个月。治疗6个月后，观察两组患儿的临床疗效及总有效率、不良反应率及脑电图(EEG)改善情况。本研究遵循的程序符合山东省鄄城县第二人民医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书。两组患儿年龄、性别、ESES病程及严重程度等比较，差异无统计学意义(P>0.05)。

实验组显效率及总有效率均略微高于对照组，但差异均无统计学意义(χ² = 0.49 ,1.95;P>0.05);实验组患儿EEG改善的显效率及总有效率均显著高于对照组，差异均有统计学意义(χ² = 11.02，7.79；P<0.01)。对照组未见与治疗相关的不良反应发生；实验组治疗过程中出现的轻微不良反应，经对症治疗消失。

甲泼尼龙冲击治疗可减少ESES患儿癫痫发作，同时可改善EEG放电，联合抗癫痫药物治疗可提高临床疗效。

To investigate the clinical curative effect about methylprednisolone pulse therapy on children with electrical status epilepticus during sleep (ESES).

From January 2008 to January 2013,a total of 56 children with ESES were recruited. According to the random number table method they were divided into experimental group (n=28) and control group (n = 28). Children with ESES in control group received routine treatment only by antiepileptic drugs, and children with ESES in experimental group received combined therapy by routine antiepileptic drugs and methylprednisolone pulse therapy. Methylprednisolone pulse therapy regimen was methylprednisolone 15 mg/( kg ? d), oral application for three days and stop using it for four days, continuous treatment for three weeks. After 6 months of treatment, clinical efficacy, adverse reactions and improvement of electroencephalogram(EEG) were observed between two groups. The study protocol was approved by the Ethical Review Board of Investigation in Second People's Hospital of Juancheng County in Shandong Province. Informed consent was obtained from the parents of each participant. There were no significant differences between two groups among gender,age, the duration and severity of ESES,et al (P>0.05).

Effective rate and total effective rate in experimental group were slightly higher than those in control group, but there were no significant differences (P>0.05). Response rate and total effective rate of improvement discharges of EEG in experimental group were much higher than those in control group, and there were significant differences between two groups (P<0.01), but there were no significant differences between two groups in effective rate of improvement of EEG (P>0.05). There were no treatment-related adverse reaction in control group. There were slight adverse reactions during treatment in experimental group, and after symptomatic treatment they were disappeared.

Methylprednisolone pulse therapy on children with ESES can reduce seizures of epilepsy and its discharges in EEG. Methylprednisolone pulse therapy combined with antiepileptic drugs can improve the clinical efficacy of children with ESES.