Effect of vaccinations on seizure risk and disease course in Dravet syndrome
Effect of vaccinations on seizure risk and disease course in Dravet syndrome
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DOI：
10.1212/wnl.0000000000001855
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发表时间：
2015-08-18
期刊：
影响因子：
9.9
通讯作者：
Brilstra, Eva H.
中科院分区：
文献类型：
--
作者：
Verbeek, Nienke E.;van der Maas, Nicoline A. T.;Brilstra, Eva H.
目的：研究疫苗相关癫痫发作对疾病病程的影响，并评估Dravet综合征（DS）婴儿百日咳合并麻疹、腮腺炎和风疹（MMR）疫苗接种后继发癫痫发作的风险。方法：回顾性分析来自医院医疗档案、儿童保健诊所和DS和致病性SCN1A突变儿童的疫苗接种登记资料。婴儿全细胞、非细胞或非百日咳联合疫苗接种后24小时内或MMR疫苗接种后5至12天内的癫痫发作被定义为“疫苗相关”。使用百日咳联合疫苗的单变量和多变量logistic回归分析了不同疫苗接种相关癫痫发作的风险，并通过使用MMR疫苗父母癫痫发作登记的自我控制病例系列分析进行了分析。比较有和没有接种疫苗相关癫痫发作的儿童的病程。结果：有和没有疫苗相关癫痫发作的DS患儿（n = 77）在首次癫痫发作的年龄（分别为21%和79%）上存在差异（中位3.7个月vs 6.1个月，p < 0.001），但在首次非疫苗相关癫痫发作的年龄、首次报告发育迟缓的年龄或认知结果上没有差异。无细胞百日咳（9%，优势比0.18,95%可信区间[CI] 0.05-0.71）和非百日咳（8%，优势比0.11,95% CI 0.02-0.59）与全细胞百日咳（37%，参考）疫苗相比，随后疫苗相关癫痫发作的风险显著降低。自我控制病例系列分析显示，在接种MMR疫苗后5至12天的危险期内，癫痫发作的发生率增加了2.3 （95% CI 1.5-3.4）。结论：我们的研究结果表明，疫苗相关的早期癫痫发作不会改变DS的病程，而随后疫苗相关癫痫发作的风险可能是疫苗特异性的。
Objective:To study the effect of vaccination-associated seizure onset on disease course and estimate the risk of subsequent seizures after infant pertussis combination and measles, mumps, and rubella (MMR) vaccinations in Dravet syndrome (DS).Methods:We retrospectively analyzed data from hospital medical files, child health clinics, and the vaccination register for children with DS and pathogenic SCN1A mutations. Seizures within 24 hours after infant whole-cell, acellular, or nonpertussis combination vaccination or within 5 to 12 days after MMR vaccination were defined as "vaccination-associated." Risks of vaccination-associated seizures for the different vaccines were analyzed in univariable and in multivariable logistic regression for pertussis combination vaccines and by a self-controlled case series analysis using parental seizure registries for MMR vaccines. Disease courses of children with and without vaccination-associated seizure onset were compared.Results:Children who had DS (n = 77) with and without vaccination-associated seizure onset (21% and 79%, respectively) differed in age at first seizure (median 3.7 vs 6.1 months, p < 0.001) but not in age at first nonvaccination-associated seizure, age at first report of developmental delay, or cognitive outcome. The risk of subsequent vaccination-associated seizures was significantly lower for acellular pertussis (9%; odds ratio 0.18, 95% confidence interval [CI] 0.05-0.71) and nonpertussis (8%; odds ratio 0.11, 95% CI 0.02-0.59) than whole-cell pertussis (37%; reference) vaccines. Self-controlled case series analysis showed an increased incidence rate ratio of seizures of 2.3 (95% CI 1.5-3.4) within the risk period of 5 to 12 days following MMR vaccination.Conclusions:Our results suggest that vaccination-associated earlier seizure onset does not alter disease course in DS, while the risk of subsequent vaccination-associated seizures is probably vaccine-specific.