Early non-convulsive seizures are associated with the development of acute encephalopathy with biphasic seizures and late reduced diffusion
Early non-convulsive seizures are associated with the development of acute encephalopathy with biphasic seizures and late reduced diffusion
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DOI：
10.1016/j.braindev.2020.11.012
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发表时间：
2021-02-26
影响因子：
1.7
通讯作者：
Nagase, Hiroaki
中科院分区：
文献类型：
--
作者：
Maruyama, Azusa;Tokumoto, Shoichi;Nagase, Hiroaki
简介：患有热性惊厥或急性脑病的儿童会出现癫痫发作和/或意识障碍，并伴有不明原因发热 (SICF)。在 SICF 儿童中，我们之前报道过，那些患有难治性癫痫持续状态或 AST 水平正常但长期神经系统异常的儿童，发生急性脑病伴双相性癫痫发作和迟发弥散减少 (AESD) 的风险很高，这被认为是由兴奋性毒性引起的。非惊厥性癫痫发作 (NCS) 在危重儿童中很常见，会导致兴奋性神经元损伤。本研究的目的是阐明发生 AESD 高风险儿童急性期 NCS 的患病率，以及急性期 NCS 与神经系统结局之间的关系。方法：我们研究了 137 名发生 AESD 高风险的 SICF 儿童，这些儿童在 2007 年 10 月至 8 月期间入住兵库县立神户儿童医院三级儿科护理中心时接受了连续脑电图监测 (cEEG)。 2018年。比较了患有NCS和不患有NCS的患者的患者特征和结果。结果：在137名儿童中，30名儿童发生NCS；首次在 cEEG 中检测到 NCS 的比例为 63.3%，在第一小时内检测到的比例为 90%，在 12 小时内检测到的比例为 96.7%。神经系统后遗症在 NCS 患者 (20.0%) 中比非 NCS 患者 (1.9%；p = 0.001) 更常见。 30 名 NCS 患者中有 5 名 (16.7%) 发生 AESD，107 名非 NCS 患者中有 3 名 (2.8%) 发生 AESD (p = 0.013)。 结论：NCS 的发生与随后的神经系统后遗症有关，尤其是 AESD 的发生。 (c) 2020 日本儿童神经病学学会 Elsevier B.V. 出版。保留所有权利。
Introduction: Children with either febrile seizure or acute encephalopathy exhibit seizures and/or impaired consciousness accompanied by fever of unknown etiology (SICF). Among children with SICF, we previously reported those who have refractory status epilepticus or prolonged neurological abnormalities with normal AST levels are at a high risk for the development of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), considered to be caused by excitotoxicity. Non convulsive seizures (NCS) are common in critically ill children and cause excitotoxic neuronal injury. The aim of this study was to elucidate the prevalence of NCS in the acute phase of children at a high risk for developing AESD and the relationship between NCS in the acute phase and neurological outcomes.Methods: We studied 137 children with SICF at a high risk for developing AESD and who underwent continuous electroencephalogram monitoring (cEEG) upon admission to a tertiary pediatric care center at Hyogo Prefectural Kobe Children's Hospital between October 2007 and August 2018. Patient characteristics and outcomes were compared between patients with NCS and without NCS.Results: Of the 137 children, NCS occurred in 30 children; the first NCS were detected in cEEG at the beginning in 63.3%, during the first hour in 90%, and within 12 h in 96.7%. Neurological sequelae were more common in NCS patients (20.0%) than in nonNCS patients (1.9%; p = 0.001). Five in 30 NCS patients (16.7%) and 3 in 107 non-NCS patients (2.8%) developed AESD (p = 0.013).Conclusion: The occurrence of NCS is associated with subsequent neurological sequelae, especially the development of AESD. (c) 2020 The Japanese Society of Child Neurology Published by Elsevier B.V. All rights reserved.