Ueda Hitoshi, Tajiri Hitoshi, Kimura Sadami, Etani Yuri, Hosoi Gaku, Maruyama Tomoko, Noma Haruyoshi, Kusumoto Yoshio, Takano Tomoko, Baba Yoshiko, Nagai Toshizaburo
Ueda Heart Clinic, 5-303 1-3 Wakihamacho Chuo-ku Kobe city, Hyogo Prefecture 651-0072, Japan; Department of Pediatrics, Osaka General Medical Center, Japan.
Department of Pediatrics, Osaka General Medical Center, Japan.
Epilepsy Res. 2015 Jan;109:146-54. doi: 10.1016/j.eplepsyres.2014.10.021. Epub 2014 Nov 6.
We analyzed the clinical features of seizures during gastroenteritis in children by comparing the norovirus and rotavirus pathogen, and the impact of fever, if present, during the seizure episodes.
Retrospective analysis was performed on 293 consecutive pediatric patients admitted with viral gastroenteritis to Osaka General Hospital between November 2007 and May 2009. Eighteen patients developed seizures, 12 of whom were positive for norovirus and six for rotavirus, as revealed by antigen detection. Of these 18 seizure patients, eight presented without fever (the aFS group) and 10 presented with febrile episodes (FS group).
Seizure patients in the rotavirus group (83%) were more likely to be febrile than those in the norovirus group (58%). Compared with the aFS group, 90% of patients in the FS group presented seizures at an early stage of gastroenteritis. The frequency of clustered seizures in the FS group was considerably higher than that of febrile seizures in general and was also as high as that of "convulsions with mild gastroenteritis (CwG)". All seizure patients, whether febrile or afebrile, presented with generalized tonic clonic seizures (GTCS), complex partial seizures (CPS), or both. Diazepam (DZP) was less effective and carbamazepine (CBZ) was completely effective for the cessation of seizures in the FS group, similar to the drug response observed in CwG.
The causative pathogen (norovirus or rotavirus) affected the frequency of febrile episodes during gastroenteritis, but fever had little effect on the clinical features of seizures. However, seizures occurred earlier during gastroenteritis in the FS group. On the whole, the clinical features of febrile seizures during viral gastroenteritis may closely resemble those of "convulsions with mild gastroenteritis" (CwG) than those of febrile seizures in general with respect to the frequency of clustered seizures and the antiepileptic drug responses and may have a pathogenic mechanism distinct from those of febrile seizures due to other causes.
通过比较诺如病毒和轮状病毒病原体，以及惊厥发作期间发热（若存在）的影响，分析儿童胃肠炎期间惊厥的临床特征。
对2007年11月至2009年5月期间连续收治于大阪综合医院的293例病毒性胃肠炎儿科患者进行回顾性分析。18例患者发生惊厥，抗原检测显示其中12例诺如病毒阳性，6例轮状病毒阳性。在这18例惊厥患者中，8例无发热表现（无热惊厥组），10例有发热发作（发热惊厥组）。
轮状病毒组惊厥患者发热的可能性（83%）高于诺如病毒组（58%）。与无热惊厥组相比，发热惊厥组90%的患者在胃肠炎早期出现惊厥。发热惊厥组簇集性惊厥的发生率显著高于一般发热惊厥，且与“轻度胃肠炎惊厥（CwG）”的发生率一样高。所有惊厥患者，无论发热与否，均表现为全身性强直阵挛性发作（GTCS）、复杂部分性发作（CPS）或两者皆有。地西泮（DZP）效果欠佳，卡马西平（CBZ）对发热惊厥组惊厥停止完全有效，类似于在CwG中观察到的药物反应。
致病病原体（诺如病毒或轮状病毒）影响胃肠炎期间发热发作的频率，但发热对惊厥的临床特征影响不大。然而，发热惊厥组惊厥在胃肠炎期间出现得更早。总体而言，病毒性胃肠炎期间发热惊厥的临床特征在簇集性惊厥频率和抗癫痫药物反应方面可能比一般发热惊厥更类似于“轻度胃肠炎惊厥”（CwG），并且可能具有与其他原因引起的发热惊厥不同的致病机制。
