8例散发儿童肉毒中毒的临床特点及神经电生理分析

Clinical and neuroelectrophysiological features of botulism in children: an analysis of eight sporadic cases

摘要:

目的 探讨儿童肉毒中毒的临床特点和神经电生理结果，旨在提高临床医师对该病的认识。方法 回顾性分析2015年8月—2022年10月湖南省儿童医院神经内科确诊的8例肉毒中毒儿童的临床资料。结果 8例患儿均有对称性颅神经麻痹和四肢弛缓性麻痹，呈下行性；7例出现呼吸肌麻痹。电生理检查结果显示，复合肌肉动作电位波幅降低5例；高频重复神经电刺激复合肌肉动作电位波幅递增超过40.0% 6例；运动单位动作电位呈短时程、低波幅及多位相4例。结论 儿童肉毒中毒的主要临床特征为从颅神经开始的对称性、下行性弛缓性麻痹，可出现呼吸肌麻痹；其电生理异常有复合肌肉动作电位波幅降低，高频重复神经电刺激复合肌肉动作电位波幅递增，运动单位动作电位呈短时程、低波幅、多位相。

Abstract:

Objective To study the clinical and neuroelectrophysiological features of botulism in children.Methods A retrospective analysis was conducted on the clinical data of eight children who were diagnosed with botulism in the Department of Neurology, Hunan Children's Hospital, from August 2015 to October 2022.Results All eight children were found to have symmetrical cranial nerve palsy and flaccid paralysis of the extremities, with a descending pattern. Seven children presented with respiratory muscle paralysis. Electrophysiological examinations revealed decreased compound muscle action potential (CMAP) amplitudes in 5 children, increased CMAP amplitudes exceeding 40.0% in 6 children during high-frequency repetitive nerve stimulation, and short duration, low amplitude, and polyphasic motor unit action potentials in 4 children.Conclusions The main clinical features of botulism in children include symmetric, descending flaccid paralysis starting from cranial nerves, with the possibility of respiratory muscle paralysis. Electrophysiological abnormalities associated with it include decreased CMAP amplitudes, increased CMAP amplitudes during high-frequency repetitive nerve stimulation, and short duration, low amplitude, and polyphasic motor unit action potentials.