小児軽症頭部外傷後のRolandic spike

ROLANDIC SPIKES FOLLOWING TRIVIAL HEAD INJURIES IN CHILDREN

I．はじめに

　小児の頭部外傷では，ささいな打撃にもかかわらず，外傷後の脳波で突発波を認め，それが外傷に関係しているものか否かの判断に困惑させられることがしばしばある。とくに焦点性の突発波を認める例では，medicolegal上の紛争もからみ，問題は複雑である。

　われわれは小児の焦点性の突発波の中でも日常，最もよくみる中心一側頭部のspike，いわゆるRolandic spikeに注目した。このRolandic spikeには，発作を有するものの他に，発作が伴なわないものもかなり存在することを経験した。Rolandic spikeが発作と合併する場合はいうまでもなくbenign epilepsy of children withcentro-temporal EEG foci （Gastant 1973），「良性（予後）小児てんかん，中心—側頭部脳波焦点型（和田豊治訳，てんかん事典，金原出版，1974）」の発作間てんかん発射である。（本稿では今後，この型のてんかんを，単に良性小児てんかんと述べることにする）。

In order to clarify the clinical significance of Rolandic spikes without epilepsy following trivial head injuries in children, 50 cases showing Rolandic spikes with or without epilepsy were compared with each other. The traumatic group consists of the cases whose spikes were found following head injuries (N=24), whereas the epileptic group consists of the cases whose spikes were found following epilepsy (N=26).

The age of onset, peak and disappearance of Rolandic spikes of the both groups were 6 years, 7 years and 12 years old respectively. As for localization of spikes and their shifting during the growth of children, no definite difference was noted stastically between both groups. CTs were performed in 29 cases (12 were of traumatic group and 17 of epileptic group), which were all normal. During follow up period of 2.5±2.4 years (mean± standerd deviation) of traumatic group, only one patient experienced an epileptic attack, although 58 per cent of them were treated with anti-convulsants.

Following remarks were concluded from our clinical analysis.

(1) Posttraumatic Rolandic spikes following trivial head injuries of children should not be regarded as posttraumatic epilepsy, but should rather be regarded as the latent type of benign epilepsy of children with centrotemporal EEG foci (Gastaut 1973).

(2) Seizure rarely occures in the latent type of benign epilepsy of children. From the literature epileptic seizures were estimated to occur in only one per cent of children with Rolandic spikes.

(3) According to our results, prophylactic admin-istration of anticonvulsants seems to be not neces-sary.

(4) The Rolandic spikes of the latent type are expected to disappear by the puberty without neurological sequelae.