Incidence and risk factors of acute encephalopathy with biphasic seizures in febrile status epilepticus |
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| Affiliation: | 1. Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan;2. Department of Pediatrics, National Hospital Organization Ureshino Medical Center, Saga, Japan;3. Department of Pediatric Neurology, Fukuoka Children''s Hospital, Fukuoka, Japan;4. Department of General Medicine, Fukuoka Children''s Hospital, Fukuoka, Japan;5. Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan;6. Department of Pediatrics, Japan Organization of Occupational Health and Safety, Yokohama Rosai Hospital, Kanagawa, Japan;7. Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan;8. Department of Pediatrics, Kitakyushu General Hospital, Fukuoka, Japan;9. Department of Pediatrics, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan;10. Department of Pediatrics, Nara Medical University, Nara, Japan;11. Department of Pediatrics, School of Medicine, Tokai University, Kanagawa, Japan;12. Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Saitama, Japan;13. Department of Pediatrics, Saga Prefectural Medical Center Koseikan, Saga, Japan;14. Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan;15. Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan;p. Department of Pediatrics, Kameda Medical Center, Chiba, Japan;q. Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan;r. Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan;s. Department of Pediatrics, Seirei Numazu Hospital, Shizuoka, Japan;t. Department of Pediatrics, Komaki City Hospital, Aichi, Japan;u. Department of Pediatric Neurology, Nagano Children’s Hospital, Nagano, Japan;v. Department of Pediatrics, Yamagata City Hospital Saiseikan, Yamagata, Japan;w. Education and Research Center for Community Medicine, Saga University, Saga, Japan |
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| Abstract: | ObjectiveTo clarify the incidence and risk factors of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in pediatric patients with febrile status epilepticus (FSE).MethodsWe retrospectively surveyed patients with FSE (≥20 min and ≥40 min) who were younger than 6 years by mailing a questionnaire to 1123 hospitals in Japan. The survey period was 2 years. We then collected clinical data on patients with prolonged febrile seizures (PFS) ≥40 min and those with AESD, and compared clinical data between the PFS and AESD groups.ResultsThe response rate for the primary survey was 42.3%, and 28.0% of hospitals which had applicable cases responded in the secondary survey. The incidence of AESD was 4.3% in patients with FSE ≥20 min and 7.1% in those with FSE ≥40 min. In the second survey, a total of 548 patients had FSE ≥40 min (AESD group, n = 93; PFS group, n = 455). Univariate analysis revealed significant between-group differences in pH, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, NH3, procalcitonin (PCT), uric acid, blood urea nitrogen, creatinine (Cr), and lactate. Multivariate analysis using stratified values showed that high PCT was an only risk factor for AESD. A prediction score of ≥3 was indicative of AESD, as determined using the following indexes: HCO3? < 20 mmol/L (1 point), Cl <100 mEq/L (1 point), Cr ≥0.35 mg/dL (1 point), glucose ≥200 mg/dL (1 point), and PCT ≥1.7 pg/mL (2 points). The scoring system had sensitivity of 84.2% and specificity of 81.0%.ConclusionIncidence data and prediction scores for AESD will be useful for future intervention trials for AESD. |
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| Keywords: | Encephalopathy Status epilepticus Febrile seizure |
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