Death within 8 years after childhood convulsive status epilepticus: a population-based study
Death within 8 years after childhood convulsive status epilepticus: a population-based study
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DOI：
10.1093/brain/awr239
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发表时间：
2011-10-01
期刊：
影响因子：
14.5
通讯作者：
Chin, Richard F. M.
中科院分区：
文献类型：
--
作者：
Pujar, Suresh S.;Neville, Brian G. R.;Chin, Richard F. M.
儿童惊厥性癫痫持续状态后的长期死亡风险及其预测因素尚不确定。我们报告了惊厥性癫痫持续状态发作后8年内的死亡率，并从英国北伦敦的一项儿科、前瞻性、以人群为基础的研究中调查了其预测因素。在目前的研究中，我们随访了一个在儿童惊厥性癫痫持续状态监测研究中确定的队列。在确定队列成员的生存状态后，我们将死亡原因定义为他们死亡证明上列出的原因。我们估计了一个标准化死亡率比，以比较我们队列与参考人群的预期死亡率。多变量考克斯回归分析用于研究癫痫持续状态时临床和人口统计学因素与随后死亡风险之间的任何关联。总病死率为11%（95%置信区间7.5-16.2%）; 7名儿童在惊厥性癫痫持续状态发作后30天内死亡，16名在随访期间死亡。我们队列的总体死亡率是参考人群预期死亡率的46倍，这主要是由于既往存在临床显著神经功能障碍的儿童在发生惊厥性癫痫持续状态急性发作时死亡率较高。既往无神经功能损害的儿童在惊厥性癫痫持续状态急性发作后存活，随访期间死亡风险未显著增加。无儿童在长期热性惊厥和特发性惊厥性癫痫持续状态后死亡。在随访期间，四分之一的死亡与顽固性癫痫发作/惊厥性癫痫持续状态有关，其余的死亡是其基础疾病的并发症。在回归分析中，惊厥性癫痫持续状态之前存在临床显著的神经功能障碍是死亡率的唯一独立危险因素。总之，儿童惊厥性癫痫持续状态后8年内死亡的风险很高，但大多数死亡与癫痫发作无关。在惊厥性癫痫持续状态时存在既存的临床显著神经功能障碍是急性发作后8年内死亡的主要风险因素。惊厥性癫痫持续状态对死亡率的作用尚不确定，但似乎比一般认为的要小。
The risk of long-term mortality and its predictors following convulsive status epilepticus in childhood are uncertain. We report mortality within 8 years after an episode of convulsive status epilepticus, and investigate its predictors from a paediatric, prospective, population-based study from north London, UK. In the current study, we followed-up a cohort previously ascertained during a surveillance study of convulsive status epilepticus in childhood. After determining the survival status of the cohort members, we defined cause of death as that listed on their death certificates. We estimated a standardized mortality ratio to compare mortality in our cohort with that expected in the reference population. Multivariable Cox regression analysis was used to investigate any association between the clinical and demographic factors at the time of status epilepticus and subsequent risk of death. The overall case fatality was 11% (95% confidence interval 7.5-16.2%); seven children died within 30 days of their episode of convulsive status epilepticus and 16 during follow-up. The overall mortality in our cohort was 46 times greater than expected in the reference population, and was predominantly due to higher mortality in children who had pre-existing clinically significant neurological impairments when they had their acute episode of convulsive status epilepticus. Children without prior neurological impairment who survived their acute episode of convulsive status epilepticus were not at a significantly increased risk of death during follow-up. There were no deaths in children following prolonged febrile convulsions and idiopathic convulsive status epilepticus. A quarter of deaths during follow-up were associated with intractable seizures/convulsive status epilepticus, and the rest died as a complication of their underlying medical condition. On regression analysis, presence of clinically significant neurological impairments prior to convulsive status epilepticus was the only independent risk factor for mortality. In conclusion, there is a high risk of death within 8 years following childhood convulsive status epilepticus but most deaths are not seizure related. Presence of pre-existing clinically significant neurological impairments at the time of convulsive status epilepticus is the main risk factor for mortality within 8 years after the acute episode. The attributable role of convulsive status epilepticus on mortality remains uncertain, but appears less than is generally perceived.