Risk factors for subsequent febrile seizures in the FEBSTAT study
Risk factors for subsequent febrile seizures in the FEBSTAT study
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DOI：
10.1111/epi.13418
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发表时间：
2016-07-01
期刊：
影响因子：
5.6
通讯作者：
Sun, Shumei
中科院分区：
文献类型：
--
作者：
Hesdorffer, Dale C.;Shinnar, Shlomo;Sun, Shumei
目的比较首次发热性癫痫持续状态(FSE)和首次单纯发热性癫痫(SFS)患儿继发发热性癫痫(FS)的风险和危险因素。为了确定后续FS的家庭使用抢救药物的情况。方法案例包括第一个FS，这是从FEBSTAT和Columbia队列中提取的FSE。对照组是第一个SFS。病例和对照按已建立的FEBSTAT方案进行分类。比较FSE组和SFS组5年内继发FS的累积风险，并进行Cox比例风险回归分析。单独的分析检查了FSE中随后的FS。随后的FSE评估了在家中使用抢救药物的情况。结果FSE与SFS相比，随后FSE的风险显著增加。任何磁共振成像(MRI)异常会使风险增加3.4倍(P<；0.05)，根据首次FS和FSE的年龄以及仅限于首次FS为FSE的儿童进行调整(任何MRI异常风险比[HR]2.9，P<；0.05)。在FSE和SFS中，任何类型的第二次FS或随后的FS持续10分钟的风险在FSE和SFS中没有差别。21名儿童中有5名(23.8%)在家中接受了直肠安定治疗，随后的FS持续10分钟。与对照组相比，FSE与随后的FSE的风险增加相关，这表明最初长时间癫痫发作的儿童有经历更长时间复发的倾向。比较FSE和SFS以及单独研究FSE时，基线MRI异常增加复发风险。少数随后持续10分钟或更长时间的FS的儿童在家中接受直肠安定治疗，尽管在第一次FSE后接受了处方。这表明有必要进一步加强对临床医生和家长的教育，以预防后续的FSE。
ObjectivesTo identify risk and risk factors for developing a subsequent febrile seizure (FS) in children with a first febrile status epilepticus (FSE) compared to a first simple febrile seizure (SFS). To identify home use of rescue medications for subsequent FS.MethodsCases included a first FS that was FSE drawn from FEBSTAT and Columbia cohorts. Controls were a first SFS. Cases and controls were classified according to established FEBSTAT protocols. Cumulative risk for subsequent FS over a 5-year period was compared in FSE versus SFS, and Cox proportional hazards regression was conducted. Separate analysis examined subsequent FS within FSE. The use of rescue medications at home was assessed for subsequent FS.ResultsRisk for a subsequent FSE was significantly increased in FSE versus SFS. Any magnetic resonance imaging (MRI) abnormality increased the risk 3.4-fold (p < 0.05), adjusting for age at first FS and FSE and in analyses restricted to children whose first FS was FSE (any MRI abnormality hazard ratio [HR] 2.9, p < 0.05). The risk for a second FS of any type or of subsequent FS lasting >10 min over the 5-year follow-up did not differ in FSE versus SFS. Rectal diazepam was administered at home to 5 (23.8%) of 21 children with subsequent FS lasting 10 min.SignificanceCompared to controls, FSE was associated with an increased risk for subsequent FSE, suggesting the propensity of children with an initial prolonged seizure to experience a prolonged recurrence. Any baseline MRI abnormality increased the recurrence risk when FSE was compared to SFS and when FSE was studied alone. A minority of children with a subsequent FS lasting 10 min or longer were treated with rectal diazepam at home, despite receiving prescriptions after the first FSE. This indicates the need to further improve the education of clinicians and parents in order to prevent subsequent FSE.