Nothing is simple about a complex febrile seizure: looking beyond fever as a cause for seizures in children.
Nothing is simple about a complex febrile seizure: looking beyond fever as a cause for seizures in children.
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复杂的热性惊厥绝非简单：除了发烧之外，还应将其视为儿童癫痫发作的原因。
DOI：
10.1542/hpeds.2013-0098
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发表时间：
2014
影响因子：
--
通讯作者：
M. Burke
中科院分区：
文献类型：
--
作者：
Sheila M Hofert;M. Burke
病例：一名16个月大的、以前健康的女孩出现发热2天。其他症状包括流涕、咳嗽、活动减少和与口服摄入量减少相关的口腔溃疡。孩子没有呕吐，腹泻，皮疹，头部外伤或其他伤害。没有生病的接触者。孩子的父亲否认家庭药物和摄入量。免疫接种是最新的，包括她的第一次流感疫苗。
在分诊时，患儿体温为39.8°C，脉搏为每分钟164次，呼吸频率为每分钟20次，血氧饱和度为98%。她看上去又累又烦躁，但可以安慰。给予患者布洛芬（10 mg/kg/剂）。当孩子被放在检查室时，她变得没有反应，有单眼斜视、流口水和对称的强直阵挛性癫痫发作活动。尽管直肠注射地西泮（0.1 mg/kg/剂），癫痫发作仍持续>10分钟，并在静脉注射咪达唑仑（0.1 mg/kg/剂）后结束。还给予对乙酰氨基酚（15 mg/kg/剂/直肠）。在20分钟的发作后，进行第二次10分钟的癫痫发作，需要静脉注射（IV）咪达唑仑（0.1 mg/kg/剂）和IV磷苯妥英负荷（20 mg/kg/剂）。
问题：目前对复杂性热性惊厥（CFS）患儿的评估和管理有哪些建议？
讨论内容：最近关于单纯性热性惊厥（SFS）管理的指南为患有这种疾病的儿童的临床医生提供了支持。1然而，在儿科CFS管理中很难找到类似的共识和指导。发热性惊厥影响2%至5%的儿童，通常年龄在6个月至5岁之间。2 25%至30%的发热性惊厥被归类为CFS，2，3定义为与发热相关的惊厥，并具有以下任何特征：持续时间>15分钟，24小时内复发，局灶性和/或相关的神经异常。
Case: A 16-month-old, previously healthy girl presented with fever for 2 days. Other symptoms included rhinorrhea, cough, decreased activity, and oral ulcerations associated with decreased oral intake. The child had no vomiting, diarrhea, rashes, head trauma or other injuries. There were no sick contacts. The child’s father denied home medications and ingestions. Immunizations were up to date and included her first influenza vaccine.
In triage the child had a temperature of 39.8°C, pulse of 164 beats per minute, respiratory rate of 20 breaths per minute, and oxygen saturation of 98%. She appeared tired and irritable but was consolable. She was given ibuprofen (10 mg/kg/dose). As the child was placed in the examination room, she became unresponsive with rightward eye deviation, drooling, and symmetric tonic-clonic seizure activity. The seizure continued for >10 minutes despite rectal diazepam (0.1 mg/kg/dose) and concluded after intravenous midazolam (0.1 mg/kg/dose). She was also given acetaminophen (15 mg/kg/dose per rectum). A 20-minute postictal period was followed by a second 10-minute seizure, which required intravenous (IV) midazolam (0.1mg/kg/dose) and a load of IV fosphenytoin (20 mg/kg/dose).
Question: What are current recommendations for the evaluation and management of a child with a complex febrile seizure (CFS)?
Discussion: Recent guidelines on management of simple febrile seizures (SFS) offer support for clinicians caring for children with this condition.1 However, similar consensus and guidance is harder to find for management of CFS in pediatrics. Febrile seizures affect 2% to 5% of children, usually aged between 6 months and 5 years.2 From 25% to 30% of febrile seizures are classified as CFS,2,3 defined as a those seizures associated with fever and with any of the following characteristics: duration >15 minutes, recurrence within 24 hours, focality, and/or associated neurologic abnormalities.4 A meta-analysis by Offringa et al5 showed …
影响因子：
6.4
作者：
LAKEMAN, FD;WHITLEY, RJ;TILLES, J
通讯作者：
TILLES, J