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[热性惊厥:现状评估]

[Febrile convulsions: assessment of current status].

作者信息

Gubser M, Blumberg A, Donati F

机构信息

Kinderspital Wildermeth, Biel.

出版信息

Schweiz Med Wochenschr. 1999 May 1;129(17):649-57.

Abstract

Febrile seizures are the most frequent neurologic disorders during childhood. The pathogenesis is not clear even today. Viral infections of the upper airways, exanthema subitum, acute otitis media, infection of the urinary tract and febrile reactions after vaccination are the most frequent precipitating factors. Predictors in identifying children with very high risk of recurrence are young age at onset, family history of febrile seizures in a first-degree relative, a history of recurrent febrile seizures and a lower degree of fever at the onset of febrile seizures. A family history of epilepsy, neurodevelopmental abnormalities and a lower degree of fever at the onset of febrile convulsion are predictors of later epilepsy in children who have febrile seizures. The prognosis of febrile seizures is very good. In the acute situation, rectal diazepam should be given in the event of prolonged febrile seizures (> 3 minutes) only. Intermittent diazepam therapy and long-term antiepileptics are not recommended. The best prophylactic treatment is education and reassurance for parents and children.

摘要

热性惊厥是儿童期最常见的神经系统疾病。即使在今天,其发病机制仍不清楚。上呼吸道病毒感染、幼儿急疹、急性中耳炎、尿路感染以及疫苗接种后的发热反应是最常见的诱发因素。识别复发风险极高儿童的预测因素包括发病年龄小、一级亲属中有热性惊厥家族史、复发性热性惊厥病史以及热性惊厥发作时体温较低。癫痫家族史、神经发育异常以及热性惊厥发作时体温较低是热性惊厥儿童日后发生癫痫的预测因素。热性惊厥的预后非常好。在急性情况下,仅在热性惊厥持续时间延长(>3分钟)时给予直肠注射地西泮。不建议采用间歇性地西泮治疗和长期抗癫痫药物治疗。最佳的预防性治疗是对家长和儿童进行教育并给予安慰。

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