Barnard C, Wirrell E
Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada.
J Child Neurol. 1999 Dec;14(12):787-94. doi: 10.1177/088307389901401204.
The aims of this study were to determine predictors of abnormal outcome, neurodevelopmental deterioration, new-onset epilepsy, refractory epilepsy, and recurrent status epilepticus in children presenting with status epilepticus. For all children presenting to Royal University Hospital, Saskatoon, Saskatchewan, Canada, with status epilepticus between January 1987 and December 1996, demographic data, details of status epilepticus (etiology, duration, treatment, and investigations), developmental milestones, seizures prior to and following status epilepticus, recurrent status epilepticus, and neurologic examination findings at status epilepticus and at follow-up were collected by chart review, patient interview, and neurologic examination. Neurodevelopmental outcome was determined for all subjects except those who died during the initial hospitalization. Predictors of new-onset epilepsy, refractory epilepsy, and recurrent status epilepticus were determined for children followed for 3 months or more after status epilepticus. At follow-up, 79% were abnormal neurologically. Predictors included etiology (nonfebrile or nonidiopathic), perinatal difficulties, preceding developmental delay, abnormal initial neurologic examination; and abnormal neuroimaging. Thirty-four percent showed neurodevelopmental deterioration; predictors included etiology (nonidiopathic or nonfebrile), young age at status epilepticus (12 months or less), and abnormal neuroimaging. Thirty-six percent with no history of seizures preceding status epilepticus developed epilepsy and 25% developed refractory epilepsy. Fifty percent of children had recurrent status epilepticus. In conclusion, very few children presenting in status epilepticus were normal at follow-up. Sequelae were seen predominantly in those with a nonidiopathic, nonfebrile etiology, whereas those with idiopathic or febrile status epilepticus did well.
本研究的目的是确定癫痫持续状态患儿出现异常结局、神经发育恶化、新发癫痫、难治性癫痫和癫痫持续状态复发的预测因素。对于1987年1月至1996年12月期间在加拿大萨斯喀彻温省萨斯卡通市皇家大学医院就诊的所有癫痫持续状态患儿，通过病历审查、患者访谈和神经检查收集人口统计学数据、癫痫持续状态的详细信息（病因、持续时间、治疗和检查）、发育里程碑、癫痫持续状态之前和之后的发作、癫痫持续状态复发以及癫痫持续状态时和随访时的神经检查结果。除了在初次住院期间死亡的患者外，对所有受试者都确定了神经发育结局。对于癫痫持续状态后随访3个月或更长时间的儿童，确定了新发癫痫、难治性癫痫和癫痫持续状态复发的预测因素。在随访时，79%的患儿神经功能异常。预测因素包括病因（非发热性或非特发性）、围产期困难、先前发育迟缓、初始神经检查异常以及神经影像学异常。34%的患儿出现神经发育恶化；预测因素包括病因（非特发性或非发热性）、癫痫持续状态时年龄较小（12个月或更小）以及神经影像学异常。癫痫持续状态之前无癫痫发作史的患儿中，36%发生了癫痫，25%发生了难治性癫痫。50%的儿童出现癫痫持续状态复发。总之，癫痫持续状态患儿在随访时很少有正常的。后遗症主要见于非特发性、非发热性病因的患儿，而特发性或发热性癫痫持续状态的患儿预后良好。
