首次热性惊厥患儿的复发率及相关因素研究

目的研究首次热性惊厥(FC)患儿106例的复发情况及可能引起复发的11种相关因素。探讨有效的防治措施，从而减少FC的复发。方法随机选择首次FC发作就诊的患儿106例，对其进行1．5～5．5年随访，随访率为95．1％，对可能影响复发的11种因素进行多元回归分析。结果首次FC的复发率为6l％，与患儿首次发病年龄，首次发病热度呈负相关；与热性惊厥家族史及患儿营养不良、反复呼吸道感染呈正相关；与患儿性别、贫血、佝偻病、围生期异常、喂养方式无相关。结论由于FC可造成惊厥性脑损伤，减少或控制FC的复发，可预防或治疗引起FC复发的上述5种因素着手，减轻或防止患儿智能损害。     

Evaluation of the protocol for management of the first uncomplicated febrile convulsion

A protocol of rationalized management of the first non complicated febrile seizure was used in 42 children and the results were compared with those observed in the past without the new protocol. The quality of medical data collected from the parents and those given to the family and their practitioner have been improved; the duration of the hospitalization was shorter, the examinations were fewer and the savings realised per child were 3,175 francs.     

Parental reactions to a child's first febrile convulsion. A follow-up investigation

The severe psychological reactions of most parents to the first febrile convulsions of their child contrast with the doctors' consideration of febrile convulsions as a simple and benign phenomenon. Fifty-two parents whose child had been admitted with febrile convulsions were interviewed about their immediate and long-term reactions. Most of the parents knew little about febrile convulsions before the fit. Parents with previous knowledge of febrile convulsions took more appropriate measures during the fit than parents without such knowledge. Sixty per cent of the parents slept restlessly for some time after the fit, 13% watched their child at night, and 29% had dyspeptic symptoms. Parents of young children should as a routine be offered general information by the family doctor about fever and febrile convulsions. Parents who have watched their child during a fit need specific information in order to avoid long-term reactions.     

Role of routine investigations in children presenting with their first febrile convulsion

To assess the role of routine investigations in children presenting with their first febrile convulsion, the results of investigations carried out in 328 children over a 2-year period were reviewed. Lumber puncture was performed in 96% of cases and resulted in the detection of 4 cases of unsuspected meningitis, one of which was bacterial. 2 children had normal lumbar punctures on admission but developed meningococcal meningitis within 48 hours. Sugar, calcium, urea, and electrolyte estimations, and blood counts were commonly performed but were unhelpful. We suggest that lumbar puncture in those children presenting with their first febrile convulsion under the age of 18 months is the only useful routine investigation.     

The first febrile convulsion: an analysis of 108 children in Saudi Arabia

In 108 children admitted to the Maternity and Children's Hospital, Riyadh with their first febrile convulsion, clinical course, management and underlying causes were analysed. There was a preponderance of boys (69%) and a mean age of 18.6 months with a peak incidence (82%) between six months and three years. The commonest precipitating conditions were upper respiratory infection and gastroenteritis. Physical findings were confined to those of the primary disease. Routine investigations, including CSF analysis were not helpful. Convulsions were mainly of the simple type, single and symmetrical, and did not last for more than 30 minutes. Two thirds of the children reached hospital within two hours of the onset of their first convulsion, and the remainder up to ten hours after the convulsion had ceased. In only 18 patients did the parents take measures to lower the temperature or revive the child. Management of febrile convulsions is discussed. Since the condition is common and, if repeated, may have serious effects, methods of educating parents are suggested.     

Role of routine investigations in children presenting with their first febrile convulsion.

To assess the role of routine investigations in children presenting with their first febrile convulsion, the results of investigations carried out in 328 children over a 2-year period were reviewed. Lumber puncture was performed in 96% of cases and resulted in the detection of 4 cases of unsuspected meningitis, one of which was bacterial. 2 children had normal lumbar punctures on admission but developed meningococcal meningitis within 48 hours. Sugar, calcium, urea, and electrolyte estimations, and blood counts were commonly performed but were unhelpful. We suggest that lumbar puncture in those children presenting with their first febrile convulsion under the age of 18 months is the only useful routine investigation.     

Factors predisposing to a complicated initial febrile convulsion.

131 consecutive admissions to hospital for a first febrile convulsion were studied to find which factors predisposed to a complicated fit--defined as one lasting more than 30 minutes, unilateral, or repeated within the same illness. A significant excess of complicated attacks occurred where the age of onset was less than 16 months, where both family history of convulsive disorder and perinatal abnormality were present, and, in females only, where it was suspected that neurological disorder preceded the first fit.     

Lower degree of fever at the initial febrile convulsion is associated with increased risk of subsequent convulsions.

We studied 132 children admitted consecutively with their first febrile convulsion to assess whether the degree of fever at the onset of the convulsion can predict the risk of subsequent convulsions. The children studied were reviewed at least 2 years after the initial febrile convulsion to determine the number of children who had recurrences of febrile convulsions and/or afebrile convulsions. Children with body temperatures below 39 degrees C at the onset of their initial febrile convulsion (Group 1) were two and half times more likely to experience multiple convulsions within the same illness than those with body temperatures above 39 degrees C (Group 2). This occurred when the body temperature rose above that which had triggered the initial febrile convulsion. Children in Group 1 were also over three times more likely to experience recurrent febrile convulsion in subsequent illnesses than those in Group 2. As for subsequent development of afebrile convulsion or epilepsy, although the risk was low, it only occurred in Group 1. It is suggested that the known association between multiple convulsions, recurrent febrile convulsions and epilepsy may be due to the single predisposing factor of a low degree of fever at the onset of febrile convulsion. Each child with febrile convulsion may have his own threshold for eliciting a convulsion with fever; the lower this threshold is, the more likely are subsequent convulsions.     

高热惊厥332例临床分析

高热惊厥是小儿常见惊厥原因之一,部分病儿反复多次发作后留有一定的后遗症,而及时、合理的处理可以有效地控制惊厥的发作,减少后遗症。现将我院儿科病房近五年来收治的高热惊厥患儿３３２例,总结如下。１临床资料１．１一般资料１９９３年～１９９７年１２月我科共收...     

Zinc in CSF of patients with febrile convulsion

Objective : This prospective study was carried out from July-December 1999 to see the status of zinc in CSF of children with febrile convulsion and to compare this to that of control.Methods : Forty-two cases of febrile convulsion and 30 controls (fever without convulsion) were enrolled into the study. CSF zinc was estimated by atomic absorption spectrophotometry (AAS) in Atomic Energy Center, Dhaka and compared between the two groups.Results : The mean zinc level in CSF in the study sample was 40.19mgm/L and that in control was 74.98mgm/L This difference was statistically significant (p<0.001).Conclusion : The study concludes that a significantly lower of zinc exists in CSF of children with febrile. However no relationship was found between CSF zinc status with age, sex, degree & duration of fever and time of lumbar puncture after convulsion.     

Zinc in CSF of patients with febrile convulsion

OBJECTIVE: This prospective study was carried out from July-December 1999 to see the status of zinc in CSF of children with febrile convulsion and to compare this to that of control. METHODS: Forty-two cases of febrile convulsion and 30 controls (fever without convulsion) were enrolled into the study. CSF zinc was estimated by atomic absorption spectrophotometry (AAS) in Atomic Energy Center, Dhaka and compared between the two groups. RESULTS: The mean zinc level in CSF in the study sample was 40.19mgm/L and that in control was 74.98mgm/L. This difference was statistically significant (p<0.001). CONCLUSION: The study concludes that a significantly lower of zinc exists in CSF of children with febrile. However no relationship was found between CSF zinc status with age, sex, degree & duration of fever and time of lumbar puncture after convulsion.     

Effects of sociodemographic factors on febrile convulsion prevalence

Background: The aim of the present study was to determine the lifetime risk (LTR) of febrile convulsion and the effects of socioeconomic factors affecting this risk among school children in Izmir province, Turkey. Methods: Information was collected from school children aged 7–17 years in a school‐based cross‐sectional study. Stratified cluster sampling technique was used to define the study population, which represents the schools located in the metropolitan area of Izmir. Data were collected through a standard questionnaire from the parents. Results: LTR was 9.7% (girls, 9.3%; boys, 10.1%, P > 0.05). The risk of febrile convulsion for children whose fathers’ education level was equal to or less than primary school was 2.13 (95% confidence interval [CI]: 1.1–4.0) and, for children whose fathers were blue collar workers it was 1.4 (95%CI: 1.0–1.8). Conclusion: LTR for febrile convulsion was relatively high in this population, consistent with studies from other developing countries. Lower socioeconomic status and lack of knowledge about febrile convulsions were main factors related to this risk.     

Recurrence risk after first febrile seizure and effect of short term diazepam prophylaxis.

In a prospective randomised study, 289 children admitted consecutively to hospital with their first febrile seizure were allocated, by date of admission, to short term diazepam prophylaxis (n = 152) or to no prophylaxis (n = 137) and followed for 18 months. In untreated children, five major risk factors for recurrent febrile convulsions were identified: age 15 months or less at the time of the first febrile seizure, epilepsy in first degree relatives, febrile convulsions in first degree relatives, a first complex febrile seizure, and day nursery care. The 18 month recurrence rate was 80 to 100% if three to five risk factors were present, 50% if two factors were identified, 25% where one factor was found, and 12% if there were no predictors. During prophylaxis the recurrence rate was uniformly low (mean 12%) in all risk groups. In high (three or more factors) and intermediate (two factors) risk children prophylaxis provided effective seizure control and reduced the recurrence rate from 80%, or more, to 12% and 50% to 12%, respectively. In children with one risk factor 50% of all recurrences were prevented (25% to 12%). Prophylaxis was ineffective in very low risk children (12% to 12%).     

小儿惊厥300例临床分析

目的：探讨300例小儿热性惊厥的临床及预后情况。方法：对300例热性惊厥患儿的病因、性别、初发年龄、初发体温、惊厥分型、家族惊厥史、脑电图、血糖及电解质变化、复发和转为癫痫的情况进行分析。结果：该组患儿的原发病主要为急性上呼吸道感染(70%);男性发病较女性稍高,男/女为1.76∶1;初发年龄为1～6岁(70%);初发体温>38.5℃者占89%;热惊厥分型中单纯型占60%;39%的患儿有复发;热惊厥后血钠、氯、镁平均值偏低,复杂型患儿的血镁均值显著低于单纯型及正常小儿,而血糖均值明显高于单纯型及正常小儿;有23例(7.7%)转为癫痫,转为癫痫者与热惊厥复发及分型有关。结论：对1～6岁的上呼吸道感染患儿,当体温≥38.5℃时应尽快采取降温措施;对热惊厥患儿应监测血糖、钠、氯、镁的变化;对反复热惊厥及复杂型患儿,应采取适当干预,以防转为癫痫。     

伴高热惊厥史的儿童癫痌病例分析

分析伴高热惊厥史的癫痌患儿的临床特点,探讨高热惊厥脑损伤及其与颞叶癫痌的关系。 方法对1996～1999年本院儿科神经病房480例住院癫痌患儿进行回顾性分析,包括首发年龄、家族史、持续时 间、癫痌发作类型、神经影像学及脑电图改变等。结果115例(23.9％)患儿有前期高热惊厥史。伴高热惊厥史 的患儿癫痌发作早且易于出现癫痌持续状态。与无高热惊厥史的患儿相比,伴高热惊厥史的患儿强直-阵挛发作 较多,复杂部分性发作较少。408例患儿曾行影像学检查,4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史 的癫痌患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫痌患儿。有6.08％(7/115)伴高热惊厥史的癫 痌惠儿和6.84％(25/365)无高热惊厥史的癫痌患儿脑电图表现为单纯颞叶异常放电,二组相比无明显差异。结论 在癫痌患儿中,高热惊厥可能伴有脑损伤,且可能与后期的癫痌发生有关,伴高热惊厥史者不一定发展为颞叶癫痌。     

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目的探讨热性惊厥(FC)继发癫癎(EP)的危险因素,以便早期干预.方法对1988年1月至2000年6月在内蒙古医学院第四附属医院儿科住院的253例FC患儿,进行5年至17年5个月随访观察.以第1次FC发作住院为随访起点,再次住院或家庭访问为随访方式,观察FC患儿继发EP的年发生率.并对FC患儿的发作持续时间、发作总次数、发作体温、首次发作24h内的发作次数、初发年龄、惊厥家族史、发作形式、首次发作48h内的脑电图、性别、原发病等可能继发EP的危险因素详细观察记录.所得资料应用生存分析寿命表和生存分析+COX回归作多元回归分析.结果随访253例FC继发EP 19例.5,10,17年继发EP年发生率分别是0.53%,1.69%,8.70%.FC发作持续时间和发作总次数,经分析分别P<0.05和P<0.01,B分别为负值和正值,分别RR<1和RR>1,其95%可信区间内均不包含1;发作形式和惊厥家族史,均P<0.01,B均为正值,均RR>1,其95%可信区间内均不包含1.结论 FC的发作持续时间长、发作总次数增多、局灶性发作及有惊厥家族史是继发EP的危险因素.