摘要： 目的 报告3例儿童“良性痫样放电”的临床表现、脑电图特点以及诊断与治疗经过，分析其误诊误治原因并探讨合理解决方案。方法与结果 回顾分析中国医学科学院北京协和医院2008年12月至2020年10月诊断与治疗的3例脑电图均呈现中央颞区棘波患儿的临床资料。例1表现为非癫痫发作，因脑电图显示中央颞区棘波误诊为“癫痫”，最终综合临床表现和脑电图诊断为夜惊症；例2无临床发作，但因脑电图显示中央颞区棘波误诊为“癫痫”且服用抗癫痫药物数年；例3虽确诊为伴中央颞区棘波的良性儿童癫痫，但在临床发作得到较好控制的情况下仍增加抗癫痫药物剂量和种类。明确诊断后，例1未予以抗癫痫药物，例2和例3逐渐减停抗癫痫药物，无一例癫痫发作。结论 “良性痫样放电”在儿童脑电图中较为常见，明确脑电图异常与临床发作之间是否存在因果关系是避免误诊误治的关键。对于脑电图表现为“良性痫样放电”的患儿，抗癫痫药物治疗的目的是控制临床发作而非消除脑电图异常。

关键词: 癫痫, 脑电描记术, 抗惊厥药

Abstract: Objective To report the clinical manifestations, EEG characteristics, diagnosis and treatment of 3 children with "benign epileptic discharge", and analyze the causes of misdiagnosis and treatment. Methods and Results The clinical data of 3 children with centrotemporal spikes (CTS) in EEG treated in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from December 2008 to October 2020 were retrospectively analyzed. Case 1 presented with non-epileptic seizure, which was misdiagnosed as "epilepsy" due to episodic events and CTS, and was eventually diagnosed as night fright based on clinical manifestations and EEG. Case 2 did not have clinical seizures, but was misdiagnosed as "epilepsy" due to CTS, and took antiepileptic drugs (AEDs) for several years. Although benign childhood epilepsy with central-temporal spikes (BECTS) was diagnosed in Case 3, the dosage and types of AEDs were increased even when the clinical seizures were well controlled. After diagnosis, AEDs was not performed in Case 1, AEDs were gradually stopped in Cases 2 and Case 3, and no epileptic seizure was observed. Conclusions "Benign epileptic discharge" is common in children's EEG examination. It is the key point to avoid the misdiagnosis and mismanagement to determine whether there is a causal relationship between EEG abnormalities and clinical seizures. For children with "benign epileptic discharge", the antiepileptic therapy is aimed at controlling clinical seizures rather than eliminating EEG abnormalities.

Key words: Epilepsy, Electroencephalography, Anticonvulsants