Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK.
Epilepsy Behav. 2019 Dec;101(Pt B):106286. doi: 10.1016/j.yebeh.2019.04.039. Epub 2019 Jun 10.
Few studies focus specifically on childhood convulsive status epilepticus (CSE). Geographical differences and study design may influence research findings. A comprehensive understanding of the outcomes of childhood CSE needs to bear these factors in mind when examining the published literature. A systematic review of the outcome of childhood CSE was carried out more than a decade ago. Since then, there have been major prospective studies (in the United Kingdom, the United States of America, and in sub-Saharan Africa (SSA)) focused on childhood CSE.
Six major prospective studies are described, and their results combined through a narrative synthesis with findings of the earlier systematic review. The following CSE outcomes are described: (1) recurrence; (2) short-term mortality; (3) subsequent epilepsy; (4) neurological, cognitive, and behavioral impairments outside of epilepsy; (5) long-term mortality; (6) association with hippocampal injury and mesial temporal sclerosis (MTS); and (7) white matter changes.
One-year recurrence after the first-ever CSE, whether its prolonged febrile seizures (PFS) or non-PFS, is 16% (95% confidence interval [CI]: 10-24). Twenty percent will have a recurrence within 4 years. Case fatality during hospitalization in high income countries is 2.7-5.2%, and 15% in SSA. The cumulative incidence of subsequent epilepsy nine years post-CSE is 25% (95% CI: 16-36). Neurological, cognitive, and behavioral impairments outside of epilepsy are detectable within 6 weeks of CSE. This persists at one year, and by 9 years follow-up, at least at third of subjects will be affected. Long-term mortality ranges from 5 to 17%, with the true estimate at 9 years follow-up to be 8% with standardized mortality ratio of 46. Mesial temporal sclerosis is uncommon, and decreased hippocampal volume is seen in both PFS and non-PFS. Duration is not but etiology/CSE type is, associated with outcome.
Childhood CSE is associated with substantial morbidity and mortality. Etiology but not duration is the main determinant. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
很少有研究专门关注儿童惊厥性癫痫持续状态（CSE）。地理位置差异和研究设计可能会影响研究结果。在检查已发表的文献时，全面了解儿童 CSE 的结果需要考虑到这些因素。十多年前，对儿童 CSE 的结果进行了系统评价。此后，已有多项关于儿童 CSE 的主要前瞻性研究（在英国、美国和撒哈拉以南非洲（SSA）进行）。
描述了六项主要的前瞻性研究，并通过叙述性综合分析将其结果与早期系统评价的结果结合起来。描述了以下 CSE 结果：（1）复发；（2）短期死亡率；（3）后续癫痫；（4）癫痫以外的神经认知和行为障碍；（5）长期死亡率；（6）与海马损伤和内侧颞叶硬化（MTS）的关系；和（7）脑白质变化。
首次 CSE 后 1 年的复发率，无论是其延长的热性惊厥（PFS）还是非 PFS，为 16%（95%置信区间[CI]：10-24）。20%的患者会在 4 年内复发。高收入国家住院期间的病死率为 2.7-5.2%，SSA 为 15%。CSE 后 9 年继发癫痫的累积发生率为 25%（95%CI：16-36）。CSE 后 6 周内可检测到癫痫以外的神经认知和行为障碍。这种情况持续到 1 年，随访 9 年时，至少有三分之一的患者会受到影响。长期死亡率为 5-17%，9 年随访时的真实估计值为 8%，标准化死亡率比为 46。MTS 并不常见，PFS 和非 PFS 均可见海马体积减小。持续时间不是，但病因/CSE 类型是决定因素。
儿童 CSE 与较高的发病率和死亡率相关。病因而不是持续时间是主要决定因素。本文是“第 7 届伦敦-因斯布鲁克癫痫持续状态和急性发作学术研讨会论文集”的一部分。
