Miyahara Hiroyuki, Akiyama Tomoyuki, Waki Kenji, Arakaki Yoshio
Department of Pediatrics, Kurashiki Central Hospital, Japan; Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Department of Pediatrics, Kurashiki Central Hospital, Japan; Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Brain Dev. 2018 Oct;40(9):781-785. doi: 10.1016/j.braindev.2018.05.014. Epub 2018 Jun 14.
Nonepileptic twilight state with convulsive manifestations (NETC) is a nonepileptic state following a febrile seizure (FS), which may be misdiagnosed as a prolonged seizure and result in overtreatment. We aimed to describe clinical manifestations of NETC and to determine characteristics that are helpful to distinguish NETC from other pathological conditions.
We conducted a retrospective chart review from January 2010 to December 2016 and selected the patients who presented with symptoms resembling status epilepticus with fever and a confirmed diagnosis using an electroencephalogram (EEG). We compared the NETC clinical features and venous blood gas analysis results with those of other conditions that mimic NETC. We also compared the characteristics of NETC with past reports.
Our NETC patients presented with short durations of the preceding generalized convulsions followed by tonic posturing, closed eyes, no cyanosis, responsiveness to painful stimulation, and no accumulation of CO in the venous blood gas. Most of these characteristics were consistent with past reports. Prolonged FS or acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) showed several of these features, but all the characteristics were not consistent with our study.
Prolonged FS and AESD need to be differentiated from NETC, and close clinical observation makes it possible to partially distinguish NETC from the other conditions. EEG is recommended for patients with symptoms that are inconsistent with these features.
伴有惊厥表现的非癫痫性朦胧状态（NETC）是热性惊厥（FS）后的一种非癫痫状态，可能被误诊为癫痫持续状态并导致过度治疗。我们旨在描述NETC的临床表现，并确定有助于将NETC与其他病理状况区分开来的特征。
我们对2010年1月至2016年12月的病历进行了回顾性分析，选择了那些出现类似癫痫持续状态症状且伴有发热，并通过脑电图（EEG）确诊的患者。我们将NETC的临床特征和静脉血气分析结果与其他类似NETC的状况进行了比较。我们还将NETC的特征与既往报告进行了比较。
我们的NETC患者在先前全身性惊厥发作持续时间较短后出现强直姿势、闭眼、无发绀、对疼痛刺激有反应，且静脉血气中无CO蓄积。这些特征大多与既往报告一致。长时间FS或伴有双相发作和晚期弥散降低的急性脑病（AESD）表现出其中一些特征，但所有特征与我们的研究并不一致。
需要将长时间FS和AESD与NETC区分开来，密切的临床观察使得部分区分NETC与其他状况成为可能。对于症状与这些特征不符的患者，建议进行脑电图检查。
