Metsäranta Piia, Koivikko Matti, Peltola Jukka, Eriksson Kai
Medical School, University of Tampere, Tampere University Hospital, Tampere, Finland.
Dev Med Child Neurol. 2004 Jan;46(1):4-8. doi: 10.1017/s0012162204000027.
Prolonged convulsive seizures are a common neurological emergency and a potential cause of neuronal damage and functional sequelae. We explored the role of seizure duration and various background factors for neurological sequelae in children with prolonged convulsive seizures. The population-base of this study was all children (age < 16 years) who had been admitted to the Tampere University Hospital, Finland between 1993 and 1999 with convulsive seizures lasting more than 5 minutes. Patients were followed up individually (mean length of follow-up 2 years 1 month, range 0 to 7 years 8 months). All available data on the prolonged seizure episodes and clinical follow-up were analyzed retrospectively by a detailed review of all medical charts and records. In 186 children (94 males, 92 females; mean age 4 years 5 months, SD 3 years 10 months, range 1 month to 15 years 4 months) there were 279 separate convulsive seizure episodes lasting over 5 minutes, yielding an annual incidence of 47.5 out of every 100000 episodes. Seizure aetiology was idiopathic in 26.2% of episodes, febrile in 41.9%, remote symptomatic in 28%, and acute symptomatic in 3.9% of episodes. Mean duration of all seizure episodes was 42.5 minutes (SD 46.1 minutes) and was significantly correlated with the aetiology: shortest in the febrile group (mean 35.4 minutes) and longest in the acute symptomatic group (mean 88.6 minutes; p < 0.001). There was no mortality related directly to these acute seizure episodes. The most common sequela was an onset of epilepsy in 40 children (22%). Permanent neurological sequelae were noted in only four patients (2.2%; mean seizure duration 16 minutes) and non-permanent sequelae in six patients (3.2%; mean seizure duration 38 minutes). Neurological sequelae of prolonged convulsive seizures in children are rare and are related to aetiological factors rather than the duration of a single seizure. The role of acute seizures in the evolution of epilepsy in children remains obscure.
长时间惊厥性癫痫发作是一种常见的神经急症，也是神经元损伤和功能后遗症的潜在原因。我们探讨了癫痫发作持续时间和各种背景因素在长时间惊厥性癫痫发作儿童神经后遗症中的作用。本研究的人群基础为1993年至1999年间入住芬兰坦佩雷大学医院、癫痫发作持续超过5分钟的所有儿童（年龄<16岁）。对患者进行个体随访（平均随访时间2年1个月，范围0至7年8个月）。通过详细查阅所有病历和记录，对所有关于长时间癫痫发作事件和临床随访的可用数据进行回顾性分析。186名儿童（94名男性，92名女性；平均年龄4岁5个月，标准差3岁10个月，范围1个月至15岁4个月）发生了279次持续超过5分钟的独立惊厥性癫痫发作事件，年发病率为每100000次发作中有47.5次。癫痫发作病因在26.2%的发作事件中为特发性，41.9%为热性，28%为远隔症状性，3.9%为急性症状性。所有癫痫发作事件的平均持续时间为42.5分钟（标准差46.1分钟），且与病因显著相关：热性组最短（平均35.4分钟），急性症状性组最长（平均88.6分钟；p<0.001）。这些急性癫痫发作事件没有直接相关的死亡病例。最常见的后遗症是40名儿童（22%）出现癫痫发作。仅4例患者（2.2%；平均癫痫发作持续时间16分钟）出现永久性神经后遗症，6例患者（3.2%；平均癫痫发作持续时间38分钟）出现非永久性后遗症。儿童长时间惊厥性癫痫发作的神经后遗症罕见，且与病因因素而非单次癫痫发作的持续时间有关。急性癫痫发作在儿童癫痫发展中的作用仍不明确。
