Lin Kuang-Lin, Lin Jainn-Jim, Hsia Shao-Hsuan, Chou Min-Liang, Hung Po-Cheng, Wang Huei-Shyong
Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung Children's Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan.
Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung Children's Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan; Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
PLoS One. 2015 Oct 7;10(10):e0139974. doi: 10.1371/journal.pone.0139974. eCollection 2015.
Encephalitis presents with seizures in the acute phase and increases the risk of late unprovoked seizures and epilepsy. This study aimed to evaluate the effect of antiepileptic drugs in pediatric patients with acute seizures due to encephalitis and epilepsy.
Cases of acute pediatric encephalitis between January 2000 and December 2010 were reviewed. Clinical data, including onset at age, seizure type, seizure frequency, effects of antiepileptic drugs, and prognosis were analyzed.
During the study period, 1038 patients (450 girls, 588 boys) were enrolled. Among them, 44.6% (463) had seizures in the acute phase, 33% had status epilepticus, and 26% (251) developed postencephalitic epilepsy. At one year of follow-up, 205 of the 251 patients with postencephalitic epilepsy were receiving antiepileptic drugs while 18% were seizure free even after discontinuing the antiepileptic drugs. Among those with postencephalitic epilepsy, 67% had favorable outcomes and were using <2 anti-epileptic drugs while 15% had intractable seizures and were using ≥ 2 antiepileptic drugs. After benzodiazepines, intravenous phenobarbital was preferred over phenytoin as treatment of postencephalitic seizures in the acute phase. For refractory status epilepticus, high-dose topiramate combined with intravenous high-dose phenobarbital or high-dose lidocaine had less side effects.
Children with encephalitis have a high rate of postencephalitic epilepsy. Phenobarbital and clonazepam are the most common drugs used, alone or in combination, for postencephalitic epilepsy.
脑炎在急性期会出现癫痫发作，并增加后期无诱因癫痫发作和癫痫的风险。本研究旨在评估抗癫痫药物对因脑炎和癫痫导致急性癫痫发作的儿科患者的疗效。
回顾了2000年1月至2010年12月期间急性儿科脑炎病例。分析了临床数据，包括发病年龄、癫痫发作类型、发作频率、抗癫痫药物的疗效及预后。
在研究期间，共纳入1038例患者（450例女孩，588例男孩）。其中，44.6%（463例）在急性期出现癫痫发作，33%出现癫痫持续状态，26%（251例）发展为脑炎后癫痫。随访一年时，251例脑炎后癫痫患者中有205例正在接受抗癫痫药物治疗，18%的患者即使停用抗癫痫药物后也无癫痫发作。在脑炎后癫痫患者中，67%预后良好，使用<2种抗癫痫药物，15%有难治性癫痫发作，使用≥2种抗癫痫药物。在急性期，除苯二氮䓬类药物外，静脉注射苯巴比妥比苯妥英更适合作为脑炎后癫痫发作的治疗药物。对于难治性癫痫持续状态，高剂量托吡酯联合静脉注射高剂量苯巴比妥或高剂量利多卡因副作用较小。
脑炎患儿发生脑炎后癫痫的比例较高。苯巴比妥和氯硝西泮是单独或联合用于脑炎后癫痫最常用的药物。
Zotero 插件