Clinical Neurosciences Department, Great Ormond Street Hospital for Children, London, UK.
Department of Neurological Sciences, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Curr Opin Pediatr. 2019 Dec;31(6):763-768. doi: 10.1097/MOP.0000000000000825.
It is widely accepted that childhood convulsive status epilepticus (CSE) has associated short-term and long-term mortality and morbidity. However, the role of CSE itself on subsequent adverse outcomes is still debated. In addition, whether prolonged seizures cause any long-term hippocampal injury and developmental or memory impairment is uncertain. In this review, we aim to provide an overview of long-term outcomes after childhood CSE, highlighting data from recent literature on this subject.
Long-term outcome after childhood CSE is favorable in previously normal children, with low incidence of epilepsy, motor and intellectual disability, behavioral impairment and need for special educational provision. Mesial temporal sclerosis is uncommon in children after prolonged febrile seizures. There is substantial morbidity after childhood CSE, but this is seen primarily in children with symptomatic causes and preexisting neurological abnormalities. Cause is the primary determinant of outcomes after childhood CSE and the additional effect of CSE characteristics such as seizure duration seems to be less than previously believed.
Childhood CSE is associated with substantial neurological, cognitive and behavioral morbidity. Early identification of these difficulties and appropriate intervention are likely to have a major positive impact on their quality of life.
儿童惊厥性癫痫持续状态(CSE)与短期和长期死亡率和发病率相关,这一观点已被广泛接受。然而,CSE 本身对后续不良结局的作用仍存在争议。此外,长时间的癫痫发作是否会导致任何长期的海马损伤、发育或记忆障碍尚不确定。在本综述中,我们旨在概述儿童 CSE 后的长期结局,重点介绍该主题的最新文献数据。
在以前正常的儿童中,儿童 CSE 后的长期预后良好,癫痫、运动和智力障碍、行为障碍和特殊教育需求的发生率较低。热性惊厥持续时间较长后,儿童出现内侧颞叶硬化的情况并不常见。儿童 CSE 后存在大量的发病率,但主要见于有症状病因和存在神经发育异常的儿童。病因是儿童 CSE 后结局的主要决定因素,CSE 特征(如发作持续时间)的附加影响似乎不如以前认为的那么大。
儿童 CSE 与严重的神经认知和行为障碍相关。早期识别这些困难并进行适当干预,可能会对他们的生活质量产生重大积极影响。