Department of Neurology, Children's National Medical Center and George Washington University School of Medicine, Washington, DC.
Division of Vaccine Injury Compensation, Department of Health and Human Services, Rockville, MD.
J Pediatr. 2015 Mar;166(3):576-81. doi: 10.1016/j.jpeds.2014.10.054. Epub 2014 Dec 2.
To describe the demographic and clinical characteristics of children for whom claims were filed with the National Vaccine Injury Compensation Program (VICP) alleging seizure disorder and/or encephalopathy as a vaccine injury.
The National VICP within the Department of Health and Human Services compensates individuals who develop medical problems associated with a covered immunization. We retrospectively reviewed medical records of children younger than 2 years of age with seizures and/or encephalopathy allegedly caused by an immunization, where a claim was filed in the VICP between 1995 through 2005.
The VICP retrieved 165 claims that had sufficient clinical information for review. Approximately 80% of these alleged an injury associated with whole-cell diphtheria, pertussis (whooping cough), and tetanus or tetanus, diphtheria toxoids, and acellular pertussis vaccine. Pre-existing seizures were found in 13% and abnormal findings on a neurologic examination before the alleged vaccine injury in 10%. A final diagnostic impression of seizure disorder was established in 69%, of whom 17% (28 patients) had myoclonic epilepsy, including possible severe myoclonic epilepsy of infancy. Specific conditions not caused by immunization, such as tuberous sclerosis and cerebral dysgenesis, were identified in 16% of subjects.
A significant number of children with alleged vaccine injury had pre-existing neurologic or neurodevelopmental abnormalities. Among those developing chronic epilepsy, many had clinical features suggesting genetically determined epilepsy. Future studies that include genotyping may allow more specific therapy and prognostication, and enhance public confidence in vaccination.
描述向国家疫苗伤害赔偿计划（VICP）提出的与癫痫发作障碍和/或脑病作为疫苗伤害有关的索赔的儿童的人口统计学和临床特征。
卫生与人类服务部的国家 VICP 为与受保免疫相关的医疗问题发展的个人提供赔偿。我们回顾性地审查了年龄在 2 岁以下的癫痫发作和/或脑病的儿童的医疗记录，据称这些儿童是由于免疫接种而导致的，在 1995 年至 2005 年期间，VICP 提出了一项索赔。
VICP 检索到 165 项具有足够临床信息可供审查的索赔。这些索赔中约有 80%声称与全细胞白喉、百日咳（百日咳）和破伤风或破伤风、白喉类毒素和无细胞百日咳疫苗有关的伤害。在 13%的患者中发现有预先存在的癫痫发作，在 10%的患者中发现有神经检查异常之前的异常发现。在 69%的患者中确立了癫痫发作障碍的最终诊断印象，其中 17%（28 例患者）患有肌阵挛性癫痫，包括可能的婴儿严重肌阵挛性癫痫。在 16%的患者中确定了与免疫接种无关的特定疾病，如结节性硬化症和脑发育不良。
相当数量的患有疫苗伤害的儿童有预先存在的神经或神经发育异常。在那些发展为慢性癫痫的儿童中，许多人具有提示遗传性癫痫的临床特征。未来包括基因分型的研究可能允许更具体的治疗和预测，并增强公众对疫苗接种的信心。
