Lux Andrew L
Department of Paediatric Neurology, Bristol Royal Hospital for Children, UBHT Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
Brain Dev. 2010 Jan;32(1):42-50. doi: 10.1016/j.braindev.2009.09.016. Epub 2009 Oct 24.
Although most febrile seizures do no harm and two-thirds of initial cases have no witnessed recurrence, the seizures cause much family anxiety, and are sometimes prolonged. In rare cases they are the first evidence of important epilepsy syndromes or are implicated in the development of epilepsy with mesial temporal sclerosis in later life. There have been trials of prophylactic treatment with antiepileptic drugs including carbamazepine, diazepam, phenobarbital, phenytoin, and sodium valproate. Several strategies have been employed with these drugs, including continuous secondary prophylaxis, intermittent secondary prophylaxis in response to later episodes of fever, and rescue medication early in the course of further seizures. Another treatment strategy has been using one or more antipyretic agents in early response to fever using agents such as acetaminophen and ibuprofen. Over the years, researchers have identified a variety of clinical, genetic, and environmental risk factors for more severe or prolonged febrile seizures and higher risk of recurrence. This review evaluates the rationale for secondary prophylaxis of febrile seizures, the potential effectiveness of such treatment, and whether it can be recommended as a general approach to treating febrile seizures or as an approach to be used in groups identified to be at increased risk.
虽然大多数热性惊厥并无危害，且三分之二的初发病例未出现复发，但惊厥会引起家庭的极大焦虑，有时还会持续较长时间。在极少数情况下，热性惊厥是重要癫痫综合征的首发表现，或与后期发生内侧颞叶硬化性癫痫有关。已经有使用抗癫痫药物（包括卡马西平、地西泮、苯巴比妥、苯妥英和丙戊酸钠）进行预防性治疗的试验。使用这些药物采用了多种策略，包括持续二级预防、针对后期发热发作的间歇性二级预防以及在进一步发作过程早期的急救用药。另一种治疗策略是在发热早期使用对乙酰氨基酚和布洛芬等一种或多种退热剂。多年来，研究人员已经确定了多种导致热性惊厥更严重或持续时间更长以及复发风险更高的临床、遗传和环境危险因素。本综述评估了热性惊厥二级预防的基本原理、这种治疗的潜在效果，以及它是否可以作为治疗热性惊厥的一般方法或用于确定为风险增加群体的方法而被推荐。
