幼童以反覆性嚴重嘔吐為表現之重積型失神性癲癇

Absence Status Epilepticus in Children Presenting with Repeated Severe Vomiting

嘔吐為兒童常見之疾病徵兆，其病因多樣，影響程度可由輕度功能障礙至嚴重危及生命的全身性疾病，涉及各系統和器官，以致診斷複雜困難。本案例為一名6歲男童，因反覆性劇烈嘔吐長達一個月，曾於外院住院治療，但病況未見好轉，輾轉至本院就醫。初始診斷為週期性嘔吐症候群（Cyclic Vomiting Syndrome, CVS）予止吐藥metoclopramide和靜脈輸液治療，住院期間觀察到個案在嘔吐後合併出現意識渙散、眼神呆滯，經腦波（Electroencephalogram）檢查方確診為重積型失神性癲癇（Absence Status Epilepticus），個案在接受抗癲癇藥物Valproic Acid後，病況獲得改善，進一步提供家庭疾病照護認知與支持，改門診治療。由此文可窺知兒童癲癇非特異與多樣性之疾病表現，臨床上遇到反覆嘔吐兒童，應密切觀察嘔吐發作過程中伴隨之症狀表現，並將癲癇列為鑑別診斷，以利早期確認診斷、提供治療。

Vomiting is a commonly observed symptom in children and has diverse etiologies, ranging from mild dysfunction to severe life-threatening systemic diseases. Thus, diagnosing the causes of vomiting is a complex challenge due to the possible involvement of various systems and organs. Here, we report the case of a 6-year-old boy who was hospitalized due to violent vomiting recurring for 1 month. When his symptoms did not improve, he was eventually transferred to our hospital for further treatment. Our initial diagnosis was cyclic vomiting syndrome, so antiemetics (metoclopramide) and intravenous fluids were administered. During his hospital stay, the patient became distracted and unresponsive after a vomiting episode. Electroencephalography was performed, and he was diagnosed with recurrent absence status epilepticus. His symptoms improved significantly following treatment with an antiepileptic drug (valproic acid). His family was provided with disease care education and support before the patient was discharged; he was followed up at the outpatient clinic. This case is a good example of the non-specific and diverse presentations of childhood epilepsy. In clinical practice, cases of recurrent vomiting in children should be closely monitored for accompanying symptoms, and epilepsy should be included in the differential diagnosis to facilitate early diagnosis and treatment.