Matsubara Yuri, Osaka Hitoshi, Yamagata Takanori, Ae Ryusuke, Shimizu Jun, Oguro Noriko
Division of Public Health, Center of Community Medicine, Jichi Medical University, Japan; Department of Pediatrics, Tochigi Rehabilitation Center, Tochigi, Japan.
Department of Pediatrics, Jichi Medical University, Japan.
Brain Dev. 2018 Oct;40(9):807-812. doi: 10.1016/j.braindev.2018.05.013. Epub 2018 Jun 8.
Acute encephalopathy causes various sequelae, including motor disabilities and intellectual delays. Previous studies reported that cognitive impairments can also occur after acute encephalitis. Although the incidence of acute encephalopathy is high in Japan, there have been few reports on its sequelae.
To characterize the neurological outcomes of pediatric patients who sought motor rehabilitation for motor dysfunction after acute encephalopathy.
Subjects were 26 children who were healthy before suffering from motor dysfunction following acute encephalopathy and were referred to our pediatric rehabilitation institute during a 9-year period (August 2007-April 2017). We examined subjects' neurological status and followed sequelae for at least 8 months.
Of 26 individuals, 21 became ambulatory after several months or years during the observation period. Patients who could sit without support within 5 months after the onset of acute encephalopathy were able to walk within several months or years. Patients showing high intensity on T2-weighted sequences or "bright tree appearance" in the frontal region took an average of 7 months to develop walking, which was longer than other patients. Among ambulatory subjects, 16(76%) exhibited mild to moderate intellectual delay with a developmental quotient (DQ) under 70, and 20 (95%) exhibited cognitive impairment. There was a significant correlation between DQ scores and motor disability (p = 0.013, r = -0.481).
Although 80% of patients who had motor dysfunction caused by acute encephalopathy and visited out motor rehabilitation outpatient clinic were eventually able to walk, the time taken to develop walking ability depended on which region exhibited magnetic resonance imaging abnormalities. DQ scores and motor disability were significantly correlated.
急性脑病会导致各种后遗症，包括运动功能障碍和智力发育迟缓。既往研究报道，急性脑炎后也可能出现认知障碍。尽管日本急性脑病的发病率较高，但关于其后遗症的报道却很少。
描述急性脑病后因运动功能障碍寻求运动康复治疗的儿科患者的神经学转归。
研究对象为26名儿童，他们在急性脑病后出现运动功能障碍之前身体健康，并在9年期间（2007年8月至2017年4月）被转诊至我们的儿科康复机构。我们检查了研究对象的神经学状况，并对后遗症进行了至少8个月的随访。
在26名研究对象中，21名在观察期内经过数月或数年能够独立行走。急性脑病发病后5个月内能够独立坐立的患者，在数月或数年内能够行走。在T2加权序列上显示高强度或额叶出现“亮树征”的患者，平均需要7个月才能学会行走，这比其他患者的时间更长。在能够独立行走的研究对象中，16名（76%）表现出轻度至中度智力发育迟缓，发育商（DQ）低于70，20名（95%）存在认知障碍。DQ评分与运动功能障碍之间存在显著相关性（p = 0.013，r = -0.481）。
尽管因急性脑病导致运动功能障碍并到我们运动康复门诊就诊的患者中，80%最终能够行走，但学会行走的时间取决于磁共振成像异常出现的部位。DQ评分与运动功能障碍显著相关。
