VIRAL PATHOGENS AND FIRST TIME SEIZURES IN THE SETTING OF ILLNESS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。对于轻度急性感染性疾病（非发热性疾病发作）中发生的首次非发热性发作知之甚少，因为这些患者传统上被排除在热性和非诱发性发作的大型流行病学研究之外，因为它们不容易使用国际分类系统进行分类。仅发表了两项系统研究（均为回顾性研究）：一项在新加坡进行，另一项由我们的研究小组进行（Zerr et al.）。Epilepsia 2005; 46:952-55)。这两项研究的结果表明，首次非热性疾病发作与首次非诱发性癫痫发作一样频繁，腹泻是伴随非热性疾病发作的特征，比热性癫痫发作更频繁，这表明特定的病原体起了作用。需要一项前瞻性研究：1)证实上述发现，2)探索非热性癫痫发作的病毒病因，3)描述非热性疾病癫痫发作的预后。为此，我们提出一项前瞻性的试点研究。我们将招募120例首次出现癫痫发作的患者：发热性、非发热性疾病或无因性疾病。将对人体标本进行各种病毒病原体检测。受试者将被随访5年，以检查随后的癫痫发作情况。本研究的数据1)将为临床医生提供管理非发热性疾病发作患者的指导和背景，2)将作为NIH申请的试点数据，通过多中心研究进一步研究这些问题，3)有可能告知我们了解癫痫发作的发病机制。试点资助正在等待Thrasher研究基金和NIH的批准。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Little is known about first-time nonfebrile seizures occurring in the setting of mild acute infectious illness (nonfebrile illness seizures) as these patients have traditionally been excluded from large epidemiological studies of both febrile and unprovoked seizures as they are not easily classified using the international classification system. Only two systematic studies (both retrospective) have been published: one set in Singapore and one performed by our research group (Zerr et al. Epilepsia 2005;46:952-55). Results from both studies suggest that first-time nonfebrile illness seizures occur as often as first-time unprovoked seizures and that diarrhea characterizes the illness accompanying nonfebrile illness seizures more frequently than febrile seizures, suggesting that specific pathogens play a role. A prospective study is needed to: 1) confirm the above findings, 2) explore viral etiologies of nonfebrile seizures, and 3) describe the prognosis of nonfebrile illness seizures. To this end we propose a prospective pilot study. We will enroll 120 patients who present to the ED with first-time seizures: febrile, nonfebrile-illness, or unprovoked. Human specimens will be tested for a variety of viral pathogens. Subjects will be followed for subsequent seizures for 5 years. Data from this study 1) will provide clinicians with guidance and context when managing patients with nonfebrile illness seizure, 2) will serve as pilot data for an NIH application to further study these questions via a multicenter study, and 3) has the potential to inform our understanding of the pathogenesis of seizures. Pilot grants are pending at the Thrasher Research Fund and the NIH.