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目的:探讨重症肌无力(MG)伴癫(EP)的发生率、机制与临床治疗。方法:回顾分析2000至2010年250例MG患者中EP的发生率。将8例MG伴发EP患者设为MG+EP组,242例不伴发EP的MG患者设为MG-EP组和200名正常体检者设为正常对照组。分析8例MG+EP组患者的临床治疗及实验检查结果。结果:250例MG患者中有8例(3.2%)有EP发作,其中MGⅡa型2例,MGⅡb型4例,MGⅢ型1例,MGⅣ型1例。癫发作类型:全身性强直-阵挛发作4例,复杂部分性发作4例,单纯部分性发作1例。脑脊液中IgG,MG+EP组明显高于MG-EP组及正常对照组(P<0.05),后两组组间差异无统计学意义(P>0.05),3组间血清中IgG差异无统计学意义(P>0.05)。MG+EP脑脊液检出抗乙酰胆碱受体抗体(AChR-Ab)。患者出现EP,单用抗癫药物(AEDs)治疗效果欠佳,EP发作在MG症状加重时频率增加,减轻时发作缓解,死亡2例。结论:①EP发作与MG的病情严重程度有关,与MG全身型可能相关;②MG+EP发作与脑脊液中IgG增高可能有关;③MG与EP相关的机制可能与脑内存在AChR-Ab有关。单用AEDs治疗效果欠佳,应同时加强MG的治疗。
Objective: To investigate the incidence, mechanism and clinical treatment of myasthenia gravis (MG) with epilepsy (EP). Methods: The incidence of EP in 250 MG patients from 2000 to 2010 was retrospectively analyzed. Eight MG patients with MG associated with EP were enrolled as MG + EP group, 242 MG patients without EP as MG-EP group and 200 normal subjects as normal control group. Analysis of 8 cases of MG + EP group of patients with clinical treatment and laboratory test results. Results: Of the 250 patients with MG, 8 (3.2%) had episodes of EP, including 2 cases of MGⅡa, 4 cases of MGⅡb, 1 case of MG Ⅲ and 1 case of MG Ⅳ. Epileptic seizure type: generalized tonic - clonic seizures in 4 cases, 4 cases of complex partial seizures, simple partial seizures in 1 case. The levels of IgG and MG + EP in CSF were significantly higher than those in MG-EP group and normal control group (P <0.05), there was no significant difference between the two groups (P> 0.05) Significance (P> 0.05). Anti-acetylcholine receptor antibody (AChR-Ab) was detected in MG + EP cerebrospinal fluid. Patients with EP, AEDs alone ineffective treatment, EP attack increased frequency of symptoms of MG increased, alleviate the onset of remission, the death of two cases. Conclusions: ①EEP episode is related to the severity of MG and may be related to the whole body of MG. ②MG + EP episode may be related to the increase of IgG in cerebrospinal fluid. ③MG and EP may be related to the presence of AChR-Ab in brain. AEDs alone are ineffective and should be treated with MG.