热性惊厥复发危险因素探讨

目的目的探讨小儿热性惊厥复发的危险因素。方法通过对102例热性惊厥患儿的临床资料进行分析，研究其复发的危险因素。结果复发48例，占47．06％，复发危险因素与惊厥家庭史、初发年龄〈1岁、惊厥时体温〈38．5℃、复杂型热性惊厥有关（P〈0．05）。结论对存在复发危险因素的热性惊厥患儿，应早期采用干预措施。     

小儿热性惊厥复发的危险因素分析

目的探讨儿童首次热性惊厥(febrile convulsion,FC)后复发的危险因素,为临床决策提供理论依据.方法对213例首次FC的患儿进行跟踪、随访,应用Logistic回归分析对所得数据进行处理.结果首次发作时惊厥次数超过2次、发病前已有中枢神经系统异常、惊厥为部分性或左右不对称性是FC复发的相关危险因素.并建立了FC复发的预测模型.结论临床工作中对于首次FC发作的患儿,如存在上述危险因素,可预防性使用抗惊厥药.     

全面惊厥性癫痫持续状态预后不良的相关因素分析

目的分析全面惊厥性癫痫持续状态（generalized convulsive status epilepticus,GCSE）预后不良的相关因素,为改善预后提供指导。方法将66例GCSE患者根据疗效分为难治性癫痫持续状态（refractory statusepil epticus,RSE）和非难治性癫痫持续状态（non-refractory status epilepticus,NRSE）,比较两组预后并分析预后不良的相关因素。结果RSE组的病因（急性症状性）、长时程发作、脑炎、并发低血压或呼吸抑制5项指标均高于NRSE组,病因（癫痫相关）低于NRSE组。多因素logistic回归分析提示脑炎及长时程发作是RSE的独立危险因素,校正的OR（95％C／）分别为39．37（6．577～235．671）、11．628（1．92～70．419）。多因素logistic回归分析还发现呼吸抑制为短期预后不良的独立危险因素,校正的OR（95％（2／）为16（3．713～68．955）。病因（急性症状性）与脑炎分别是远期恢复至发病前与遗留癫痫的独立影响因素,校正的OR（95％C／）分别为0．127（0．027～0．604）、7．7（1．661～35．692）。结论脑炎及长时程发作是RSE的独立危险因素;呼吸抑制与短期预后不良（死亡或昏迷）独立相关;病因（急性症状性）与脑炎分别是恢复至发病前与遗留癫痫的独立危险因素。     

成年人非惊厥癫痫持续状态

成年人非惊厥癫痫持续状态人群发病率在1.5/10万以上,约占癫痫持续状态的25％。分为失神持续状态和复杂部分发作持续状态。因其缺乏惊厥活动而临床表现多种多样,确诊有赖于EEC。成年人和儿童发病机理可能存在本质区别。而预后与正确的诊断和及时有效的处理有关。     

成人顽固性癫痫持续状态的临床分析

目的 探讨成人顽固性癫痫持续状态（RSE）的危险因素、临床特点、治疗及预后。方法 54例癫痫持续状态（SE）．58次发作事件，分为RSE组和非顽固性癫痫持续状态（NRSE）组．对病因、诱因、临床表现、辅助检查、预后等进行对比分析。结果 RSE占SE的43．1％，病毒性脑炎是RSE最主要的病因（P=0．001），相反，既往癫痫发作在NRSE中更常见（P=0．000），相应地药物治疗的改变引起的SE多为NRSE（P=-0．003）；RSE组GCS评分及预后较NRSE组均差（均P=0．000）。结论 SE经一、二线抗癫痫药治疗后仍有很大一部分难以控制，病毒性脑炎是导致RSE的一个重要病因，其预后较差．目前对RSE的治疗还缺乏十分合理的方案。     

186例热性惊厥儿童的脑电图分析

目的：探讨热性惊厥（ＦＣ）时异常脑电图（ＥＥＧ）与以后癫痫的发作,与ＦＣ的再发及预防性治疗的关系。方法：记录１８６例４－６岁患儿ＦＣ后ＥＥＧ。结果：首次ＥＥＧ异常率为３３％;ＥＥＧ异常率与Ⅰ级亲属的热惊厥史无关系;ＥＥＧ异常率与ＦＣ临床特征（局灶性发作和ＦＣ持续时间〉１５分钟）有关;首次ＦＣ的ＥＥＧ异常率为１２％,随着ＦＣ再发次数的增多逐渐增高,ＦＣ再３次以上的患儿中,其ＥＥＧ异常率高达３５．８％～５３．３％;３岁以内ＦＣ儿其ＥＥＧ异常率不明显,３岁以后的ＦＣ儿ＥＥＧ的异常率则逐渐增多,有统计意义;部分患儿多次ＥＥＧ检查出现发作性棘波,其中３例随访４～８年,最后诊断为癫痫。结论：ＥＥＧ异常主与Ⅰ级亲属是否有ＦＣ史无关,与ＦＣ临床特征有关系;ＦＣ再发与ＥＥＧ异常、年龄有明显关系：ＥＥＧ多次异常ＦＣ可发展为癫痫;建     

惊厥性癫痫持续状态的现代概念与治疗

惊厥性癫痫持续状态(CSE)是一种危胁生命的神经系统急症,但在许多方面对其了解还极为有限,并存在争议。本文对CSE的定义、临床分类、病理生理与发病机制和治疗方面近年来的进展进行了综述,特别强调EEG监护在CSE治疗中的作用和认识CSE后非惊厥性癫痫持续状态在治疗方面的重要性。     

小儿热性惊厥复发相关因素探讨

热性惊厥(FC)是婴幼儿时期最常见的惊厥性疾病,与年龄相关[1]。若该病持时间较长会导致大脑发育时损伤,临床发现有的患儿出现智力减弱和癫病。1980年美国国家卫生研究院(NIH)将热性惊厥定义为:3个月～5岁发生的惊厥,伴有发热但无颅内感染等特定原因,凡是过去发生过无热惊厥者,其伴有发热的惊厥应排除在热性惊厥之外[2]。绝大多数患儿预后良好,约有1/3的患儿出现复发,后者可     

老年惊厥性癫痫持续状态28例临床分析

目的观察老年惊厥性癫痫持续状态(CSE)的临床特点。方法收集神经重症监护室(NICU)年龄≥60岁的CSE患者28例,回顾性分析其临床特点。结果脑血管病为28例老年CSE的首位病因。接受抗癫痫药物治疗后,CSE症状控制的中位时间为0.9 h,其中16例患者在1 h内症状控制,12例为难治性癫痫持续状态(RSE)。28例患者中,存活16例、死亡12例。死亡者与存活者相比,合并中枢神经系统新发疾病(P=0.027)和RSE的比例显著不同(P=0.027)。结论老年CSE患者基础情况差,病因多样,合并有中枢神经系统新发疾病或有RSE者的死亡率高。     

误诊为非惊厥性癫痫持续状态的胰岛素瘤一例

目的了解非惊厥性癫痫持续状态(NCSE)的误诊原因及胰岛素瘤的诊断及治疗方法。方法分析我院以"非惊厥性癫痫持续状态"收治的1例误诊病例的临床特点。结果胰岛素瘤由于其临床表现多种多样及肿瘤发生的隐蔽性,误诊率较高,部分患者长期被误诊为神经精神系统疾病而延误治疗。该病典型的Whipple三联征表现、胰岛素释放指数增高及胰腺占位性病变对正确诊断有重要作用。结论胰岛素瘤是相对少见的一种胰腺肿瘤,本例貌似非惊厥性癫痫发作为首发症状,因临床表现多样容易误诊,目前手术治疗为首选治疗方法。     

脑炎后癫痫持续状态进展为难治性癫痫持续状态及超级难治性癫痫持续状态的早期预测因素

目的 探讨脑炎后癫痫持续状态(SE)进展为难治性SE(RSE)及超级RSE(SRSE)的早期预测因素.方法 根据疾病进展情况将89例脑炎后SE患者分为非RSE组、RSE组及SRSE组.比较各组临床资料.结果 非RSE组、RSE组及SRSE组年龄、SE严重程度评分量表(STESS)评分、基于流行病学SE病死率评分(EMS...     

Risk factors for recurrences of febrile convulsions

Risk factors for predicting recurrences of febrile seizures were studied in an unselected series of 169 children after their first febrile seizure. Follow-up data covering 2.1–6.8 (mean 3.8) years from the first febrile seizure were available from 167 of them (98.8%) including 72 girls. Altogether 35/167 (21.0%, 95% confidence intervals (CI) 14.6% to 29.1%) had further febrile seizures, and multivariate logistic regression analysis showed the number of febrile episodes (p = 0.011) and the occurrence of such seizures among first degree relatives (p = 0.015, relative risk 3.75, CI 1.22 to 11.5) to be significant risk factors for recurrences. Our findings indicate that more emphasis should be placed on preventing febrile episodes rather than concentrating only on preventing seizures with antiepileptic therapy.     

Periodic febrile confusion as a presentation of complex partial status epilepticus

A 75-year-old woman was evaluated for recurrent episodes of fever she experienced periodically every 4-5 weeks over the last 12 months, lasting 2-3 days each. The fever was associated with continuous complex partial seizures, paralleled the seizure activity and returned to normal after the seizures had ceased. The ictal EEG recordings showed rhythmic bitemporal 3-4 Hz activity; the interictal recordings showed a spike and wave discharge over the right fronto-temporal region. Carbamazepine effectively controlled both the seizures and the fever; the latter was presumed to be an inherent manifestation of the seizure activity.     

The role of EEG in febrile status epilepticus (FSE)

Febrile status epilepticus is an important neurological emergency and a risk factor for later development of epilepsy. There are guidelines recommending against the use of EEG in the evaluation of simple febrile seizures but the role in febrile status epilepticus is not well established. This article reviews the literature on the role of EEG in the evaluation of the patient with prolonged febrile seizures, summarizes the findings, and concludes with some simple recommendations based upon the existing knowledge. At least 30–40% of EEGs obtained within one week of febrile status epilepticus will contain abnormalities including focal slowing. In some series focal slowing appears to be associated with development of a spike focus in the same location. Prospective series with large numbers of patients and follow-up are required to ascertain whether such abnormalities are associated with later development of epilepsy.     

Aborted and refractory status epilepticus in children: a comparative analysis

PURPOSE: The aims of this retrospective study were: (1) to compare the demographics, clinical characteristics, etiology, and EEG findings of status epilepticus aborted with medication (ASE) and refractory status epilepticus (RSE), (2) to describe the treatment response of status epilepticus (SE), and (3) to determine predictors of long-term outcome in children with SE. METHODS: Medical records and EEG lab logs with ICD-9 diagnostic codes related to SE were reviewed. Patients younger than 18 years of age, hospitalized in 1994-2004 at the Mayo Clinic, Rochester, were included. RESULTS: One hundred fifty-four children had SE; 94 (61%) had ASE, and 60 (39.0%) had RSE. Family history of seizures, higher seizure frequency score, higher number of maintenance antiepileptic drugs (AEDs), nonconvulsive SE, and focal or electrographic seizures on initial EEG were associated with RSE by univariate analysis. In-hospital mortality was significantly higher in RSE (13.3%) than in ASE (2.1%). In the long term, survivors with RSE developed more new neurological deficits (p < 0.001) and more epilepsy (p < 0.004) than children with ASE. Children treated in a more aggressive fashion appeared to have better treatment responses (p < 0.001) and outcomes (p = 0.03). Predictors of poor outcome were long seizure duration (p < 0.001), acute symptomatic etiology (p = 0.04), nonconvulsive SE (NCSE) (p = 0.01), and age at admission <5 years (p = 0.05). DISCUSSION: Several patient and clinical characteristics are associated with development of RSE and poor outcome. Prospective, randomized trials that assess different treatment protocols in children with SE are needed to determine the optimal sequence and timing of medications.