Kimia Amir A, Bachur Richard G, Torres Alcy, Harper Marvin B
aDivision of Emergency Medicine, Boston Children's Hospital bPediatric Neurology, Boston Medical Center cDivision of Emergency Medicine, Pediatric Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2015 Jun;27(3):292-7. doi: 10.1097/MOP.0000000000000220.
The review describes current evidence on the evaluation of febrile seizures in the acute setting, the need for further outpatient assessment, and predictors regarding long-term outcomes of these patients.
New evidence has been added in support of limited assessment and intervention: evidence on low utility of lumbar puncture, emergent neuroimaging, and follow-up electroencephalography, as well as low yield for antipyretic prophylaxis and intermittent use of antiepileptic drugs. Finally, there is growing evidence regarding the genetic basis of both febrile seizures and vaccine-related seizures/febrile seizures.
Routine diagnostic testing for simple febrile seizures is being discouraged, and clear evidence-based guidelines regarding complex febrile seizures are lacking. Thus, clinical acumen remains the most important tool for identifying children with seizures who are candidates for a more elaborate diagnostic evaluation. Similarly, evidence and guidelines regarding candidates for an emergent out-of-hospital diazepam treatment are lacking.
本综述阐述了当前关于急性发热性惊厥评估、进一步门诊评估需求以及这些患者长期预后预测因素的证据。
已有新证据支持有限的评估和干预：腰椎穿刺、急诊神经影像学检查及随访脑电图效用低的证据，以及退热预防和间歇性使用抗癫痫药物收益低的证据。最后，关于发热性惊厥和疫苗相关惊厥/发热性惊厥的遗传基础，证据越来越多。
不鼓励对单纯性发热性惊厥进行常规诊断检测，且缺乏关于复杂性发热性惊厥的明确循证指南。因此，临床敏锐度仍是识别需要更详细诊断评估的惊厥患儿最重要的工具。同样，缺乏关于院外紧急使用地西泮治疗候选者的证据和指南。
