The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital
The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital
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DOI：
10.1186/1471-2431-8-5
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发表时间：
2008-02-08
期刊：
影响因子：
2.4
通讯作者：
Newton, Charles R. J. C.
中科院分区：
文献类型：
--
作者：
Idro, Richard;Gwer, Samson;Newton, Charles R. J. C.
背景资料：急性癫痫发作是资源贫乏国家儿科住院的常见原因，也是神经和认知障碍及癫痫的风险因素。我们确定了发病率，病因学因素和癫痫发作的直接结果在农村疟疾流行区在沿海Kenya.Methods：我们招募了所有儿童和没有癫痫发作，年龄0-13岁，并承认基利菲区医院超过2年，从2004年12月1日至2006年11月30日。仅包括来自指定区域的事件入院。排除癫痫患者。人口分母，在2005年11月30日（研究中点）在社区的儿童人数，从人口普查data.Results建模：癫痫发作报告在900/4,921（18.3%）事件入院，至少有98癫痫持续状态。0-13岁儿童中急性癫痫发作的发生率为425（95% CI 386，466）/100，000/年，< 5岁儿童中为879（95% CI 795，968）/100，000/年。然而，这一发病率数据可能低估了社区的真实发病率。超过80%的癫痫发作与感染有关。新生儿感染（28/43 [65.1%]）和恶性疟（476/821 [58.0%]）分别是新生儿和6个月以上儿童癫痫发作的主要相关疾病。恶性疟也是与癫痫持续状态相关的主要疾病（56/98 [57.1%]）。与癫痫发作有关的其他疾病包括化脓性脑膜炎、呼吸道感染和胃肠炎。28名癫痫发作儿童（3.1%）死亡，11名幸存儿童（1.3%）出院时出现严重神经功能障碍。癫痫持续状态，局灶性癫痫发作，昏迷，代谢性酸中毒，菌血症，化脓性脑膜炎与死亡率独立相关，而癫痫持续状态，缺氧缺血性脑病和化脓性脑膜炎独立与神经功能缺损discharge.Conclusion：有一个高发病率的急性癫痫发作的儿童生活在肯尼亚疟疾流行区。最重要的原因是可用公共卫生计划预防的疾病。
Background: Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya.Methods: We recruited all children with and without seizures, aged 0-13 years and admitted to Kilifi District hospital over 2 years from 1(st) December 2004 to 30(th) November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint), was modelled from a census data.Results: Seizures were reported in 900/4,921(18.3%) incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0-13 years was 425 (95% CI 386, 466) per 100,000/year and was 879 (95% CI 795, 968) per 100,000/year in children < 5 years. This incidence data may however be an underestimate of the true incidence in the community. Over 80% of the seizures were associated with infections. Neonatal infections (28/43 [65.1%]) and falciparum malaria (476/821 [58.0%]) were the main diseases associated with seizures in neonates and in children six months or older respectively. Falciparum malaria was also the main illness (56/98 [57.1%]) associated with status epilepticus. Other illnesses associated with seizures included pyogenic meningitis, respiratory tract infections and gastroenteritis. Twenty-eight children (3.1%) with seizures died and 11 surviving children (1.3%) had gross neurological deficits on discharge. Status epilepticus, focal seizures, coma, metabolic acidosis, bacteraemia, and pyogenic meningitis were independently associated with mortality; while status epilepticus, hypoxic ischaemic encephalopathy and pyogenic meningitis were independently associated with neurological deficits on discharge.Conclusion: There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.