Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study
Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study
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DOI：
10.1016/s1474-4422(10)70107-1
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发表时间：
2010-06-01
期刊：
影响因子：
48
通讯作者：
Berkovic, Samuel F.
中科院分区：
文献类型：
--
作者：
McIntosh, Anne M.;McMahon, Jacinta;Berkovic, Samuel F.
背景百日咳疫苗接种据称会引起脑病，包括癫痫发作和随后的智力残疾。在先前的一项回顾性研究中，14名所谓的疫苗脑病患者中有11名患有Dravet综合征，该综合征与钠通道基因SCN 1A的新生突变有关。在这项研究中，我们的目的是建立Dravet综合征与疫苗接种的明显关联是否是由回忆偏倚引起的，如果不是，疫苗接种是否会影响发病或结果的disorder.Methods我们回顾性研究了Dravet综合征患者谁有突变的SCN 1A，其第一次癫痫发作是惊厥，并为谁验证源数据可用。我们分析了医疗和疫苗接种记录，以调查这些患者的疫苗接种和癫痫发作之间是否存在关联。根据癫痫发作是否在接种疫苗后不久发生（近距离接种组）或未发生（远距离接种组），将患者分为两组。我们比较了临床特征，智力成果，和类型的SCN 1A突变groups.Findings之间的接种疫苗和癫痫发作的日期可从源记录为40例。我们确定了在接种疫苗后2天内癫痫发作的患者数量的峰值。因此，在接种当天或接种后当天癫痫发作的患者（n=12）被纳入近距离接种组，在接种后2天或更长时间（n=25）或接种前（n=3）癫痫发作的患者被纳入远距离接种组。近距离接种组癫痫发作时的平均年龄为18.4周（SD 5.9），远距离接种组为26.2周（8.1）（差异7.8周，95% CI 2.6-13.1; p=0.004）。两组之间的智力结果、随后的癫痫发作类型或突变类型没有差异（所有p值>0.3）。此外，在一项事后分析中，智力结果并没有不同的患者接受疫苗接种后，癫痫发作发作和那些谁not.Interpretation疫苗接种可能会触发Dravet综合征的儿童，因为SCN 1A突变，是注定要发展的疾病的早期发病。然而，不应该对SCN 1A突变的儿童停止接种疫苗，因为我们没有发现任何证据表明在疾病发作之前或之后接种疫苗会影响结果。
Background Pertussis vaccination has been alleged to cause an encephalopathy that involves seizures and subsequent intellectual disability. In a previous retrospective study, 11 of 14 patients with so-called vaccine encephalopathy had Dravet syndrome that was associated with de-novo mutations of the sodium channel gene SCN1A. In this study, we aimed to establish whether the apparent association of Dravet syndrome with vaccination was caused by recall bias and, if not, whether vaccination affected the onset or outcome of the disorder.Methods We retrospectively studied patients with Dravet syndrome who had mutations in SCN1A, whose first seizure was a convulsion, and for whom validated source data were available. We analysed medical and vaccination records to investigate whether there was an association between vaccination and onset of seizures in these patients. Patients were separated into two groups according to whether seizure onset occurred shortly after vaccination (vaccination-proximate group) or not (vaccination-distant group). We compared clinical features, intellectual outcome, and type of SCN1A mutation between the groups.Findings Dates of vaccination and seizure onset were available from source records for 40 patients. We identified a peak in the number of patients who had seizure onset within 2 days after vaccination. Thus, patients who had seizure onset on the day of or the day after vaccination (n=12) were included in the vaccination-proximate group and those who had seizure onset 2 days or more after vaccination (n=25) or before vaccination (n=3) were included in the vaccination-distant group. Mean age at seizure onset was 18.4 weeks (SD 5.9) in the vaccination-proximate group and 26.2 weeks (8.1) in the vaccination-distant group (difference 7.8 weeks, 95% CI 2.6-13.1; p=0.004). There were no differences in intellectual outcome, subsequent seizure type, or mutation type between the two groups (all p values >0.3). Furthermore, in a post-hoc analysis, intellectual outcome did not differ between patients who received vaccinations after seizure onset and those who did not.Interpretation Vaccination might trigger earlier onset of Dravet syndrome in children who, because of an SCN1A mutation, are destined to develop the disease. However, vaccination should not be withheld from children with SCN1A mutations because we found no evidence that vaccinations before or after disease onset affect outcome.