Camfield P, Camfield C
Department of Pediatrics, IWK Grace Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Epilepsia. 2000 Sep;41(9):1230-3. doi: 10.1111/j.1528-1157.2000.tb00331.x.
Experts have suggested that when the first two (or more) unprovoked seizures occur on the same day, they should be considered as a single event and the diagnosis of epilepsy await a further seizure. We have studied the subsequent clinical course of children with their first two seizures on the same day ("same day" group) compared with children with their first two seizures separated by more than one day ("different day" group).
The Nova Scotia childhood epilepsy database documented all newly diagnosed children with epilepsy from 1977 to 1985 with follow-up in 1990 and 1991. Epilepsy was defined as two or more unprovoked seizures regardless of the interval between seizures provided that consciousness fully returned between seizures. All patients had their first seizure between the ages of 1 month and 16 years. Seizure types were restricted to partial, generalized tonic-clonic, and partial with secondary generalization.
Of the 490 children with partial or generalized tonic-clonic seizures and follow-up of more than 2 years, 70 had their first two or more seizures on the same day and 420 had their first two seizures on different days. Eighty percent (56 of 70) of the "same day" group subsequently had one or more further seizures with (n = 14) or without (n = 42) medication; 80.9% (340 of 420) of the "different day" group had one or more further seizures with (n = 115) or without (n = 225) medication. Seizure types were nearly identical. Cause was the same (except for fewer idiopathic "genetic" cases in the "same day" group: 1 of 70 vs. 42 of 420; p = 0.02). Rates of mental handicap and previous febrile seizures were the same. Children in the "same day" group were younger on average (60 vs. 84 months; p = 0.001) and were somewhat more likely to have neurological impairment. Outcome after 7 years average follow-up was the same: 58% of the "same day" group and 56% of the "different day" group were in remission.
If two or more unprovoked seizures (with normal consciousness between) occur on the same day, the child appears to have epilepsy and will have a clinical course identical to that of the child with a longer time interval between the first two seizures.
专家建议，当首次出现的两次（或更多次）无诱因癫痫发作发生在同一天时，应将它们视为单次发作事件，癫痫的诊断需等待进一步发作。我们研究了同一天出现首次两次癫痫发作的儿童（“同一天”组）与首次两次癫痫发作间隔超过一天的儿童（“不同天”组）随后的临床病程。
新斯科舍省儿童癫痫数据库记录了1977年至1985年所有新诊断的癫痫儿童，并于1990年和1991年进行随访。癫痫被定义为两次或更多次无诱因发作，无论发作间隔时间多长，前提是发作期间意识完全恢复。所有患者首次发作年龄在1个月至16岁之间。发作类型限于部分性、全身性强直阵挛性发作以及部分性发作继发全身性发作。
在490例有部分性或全身性强直阵挛性发作且随访超过2年的儿童中，70例同一天出现首次两次或更多次发作，420例首次两次发作在不同天。“同一天”组中80%（70例中的56例）随后出现一次或更多次进一步发作，其中14例使用药物，42例未使用药物；“不同天”组中80.9%（420例中的340例）出现一次或更多次进一步发作，其中115例使用药物，225例未使用药物。发作类型几乎相同。病因相同（“同一天”组特发性“遗传”病例较少除外：70例中的1例对比420例中的42例；p = 0.02）。智力障碍发生率和既往热性惊厥发生率相同。“同一天”组儿童平均年龄更小（60个月对比84个月；p = 0.001），且更有可能存在神经功能损害。平均随访7年后的结果相同：“同一天”组58%缓解，“不同天”组56%缓解。
如果同一天出现两次或更多次无诱因发作（发作期间意识正常），该儿童似乎患有癫痫，其临床病程与首次两次发作间隔时间更长的儿童相同。
