Maegaki Yoshihiro, Kurozawa Youichi, Tamasaki Akiko, Togawa Masami, Tamura Akiko, Hirao Masato, Nagao Akihisa, Kouda Takayuki, Okada Takayoshi, Hayashibara Hiroshi, Harada Yuichiro, Urushibara Makoto, Sugiura Chitose, Sejima Hitoshi, Tanaka Yuji, Matsuda-Ohtahara Hiroko, Kasai Takeshi, Kishi Kazuko, Kaji Syunsaku, Toyoshima Mitsuo, Kanzaki Susumu, Ohno Kousaku
Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan.
Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan.
Brain Dev. 2015 May;37(5):478-86. doi: 10.1016/j.braindev.2014.08.004. Epub 2014 Sep 2.
Early predictors of status epilepticus (SE)-associated mortality and morbidity have not been systematically studied in children, considerably impeding the identification of patients at risk.
To determine reliable early predictors of SE-associated mortality and morbidity and identify the etiology of SE-associated sequelae in Japanese children.
We conducted a prospective multicenter study of clinical findings and initial laboratory data acquired at SE onset, and assessed outcomes at the last follow-up examination. In-hospital death during the acute period and neurological sequelae were classified as poor outcomes.
Of the 201 children who experienced their first SE episode, 16 exhibited poor outcome that was most commonly associated with acute encephalopathy. Univariate analysis revealed that the following were associated with poor outcomes: young age (⩽24 months); seizure duration >90 min; seizure intractability (failure of the second anticonvulsive drug); biphasic seizures; abnormal blood glucose levels (<61 or >250 mg/dL); serum aspartate aminotransferase (AST) ⩾56 U/L; and C-reactive protein (CRP) levels >2.00 mg/dL. Multivariate analysis revealed that young age, seizure intractability, abnormal blood glucose levels, and elevated AST and CRP levels were statistically significant.
Young age and seizure intractability were highly predictive of poor outcomes in pediatric SE. Moreover, abnormal blood glucose levels and elevated AST and CRP levels were predictors that might be closely associated with the etiology, especially acute encephalopathy and severe bacterial infection (sepsis and meningitis) in Japanese children.
儿童癫痫持续状态（SE）相关死亡率和发病率的早期预测因素尚未得到系统研究，这在很大程度上阻碍了对高危患者的识别。
确定日本儿童SE相关死亡率和发病率的可靠早期预测因素，并确定SE相关后遗症的病因。
我们对SE发作时获得的临床发现和初始实验室数据进行了一项前瞻性多中心研究，并在最后一次随访检查时评估了结果。急性期住院死亡和神经后遗症被归类为不良结局。
在201名首次发生SE发作的儿童中，16名出现了不良结局，最常见的是与急性脑病相关。单因素分析显示，以下因素与不良结局相关：年龄小（≤24个月）；发作持续时间>90分钟；癫痫发作难以控制（第二种抗惊厥药物治疗失败）；双相性发作；血糖水平异常（<61或>250mg/dL）；血清天冬氨酸转氨酶（AST）≥56U/L；以及C反应蛋白（CRP）水平>2.00mg/dL。多因素分析显示，年龄小、癫痫发作难以控制、血糖水平异常以及AST和CRP水平升高具有统计学意义。
年龄小和癫痫发作难以控制高度预测小儿SE的不良结局。此外，血糖水平异常以及AST和CRP水平升高是可能与病因密切相关的预测因素，尤其是日本儿童的急性脑病和严重细菌感染（败血症和脑膜炎）。
