已知患有癫痫或新发癫痫的儿童癫痫发作和癫痫持续状态的诊断评估与管理：一项回顾性比较分析。

Diagnostic evaluation and management of seizures and status epilepticus in children with known epilepsy or new-onset seizures: A retrospective and comparative analysis.

作者信息

Le Coz J, Chéron G, Nabbout R, Patteau G, Heilbronner C, Hubert P, Renolleau S, Oualha M

机构信息

Urgences pédiatriques, Hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.

Urgences pédiatriques, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.

出版信息

Arch Pediatr. 2020 Feb;27(2):66-71. doi: 10.1016/j.arcped.2019.12.001. Epub 2020 Jan 18.

DOI:10.1016/j.arcped.2019.12.001

PMID:31964545

Abstract

OBJECTIVES

The purpose of this study was to describe and compare the initial management, including clinical/biological investigation and treatment, of new-onset seizures and status epilepticus (SE) in children versus seizures and SE in those with known epilepsy.

METHODS

This was a retrospective, single-center, observational study conducted in an urban pediatric hospital in Paris. All patients, aged from 1 month to 18 years, admitted to the pediatric intensive care unit, the high-dependency care unit, and those who required hospitalization in the short-term unit of the emergency department between January 1 and December 31, 2014 for seizures and/or SE were included.

RESULTS

We analyzed the data of 190 children: new-onset seizures (N=118; group A) versus those with known epilepsy (N=72; group B). At least one diagnostic test was performed on 156 patients (82.1%) (group A, N=104, 88.1%; group B, N=52, 72.2%; P=0.05). In group B, blood levels of antiepileptic drugs were measured in 14 of the 38 patients with SE, of whom six were under dosed. Treatments were: first line, diazepam (group A, 80%; group B, 46%; P<0.001); second line, diazepam (group A, 56%; group B, 34%; P=0.02) or clonazepam (group A, 24%; group B, 46%; P=0.001); third line, phenytoin (group A, 54%; group B, 22%; P<0.001) or clonazepam (group A, 18%; group B, 61%; P<0.001).

CONCLUSION

Diagnostic evaluation and treatment should be individualized for children with known epilepsy.

摘要

目的

本研究旨在描述和比较儿童新发癫痫发作和癫痫持续状态（SE）与已知癫痫患者的癫痫发作和SE的初始管理，包括临床/生物学检查和治疗。

方法

这是一项在巴黎一家城市儿科医院进行的回顾性、单中心观察性研究。纳入了2014年1月1日至12月31日期间入住儿科重症监护病房、高依赖护理病房以及那些因癫痫发作和/或SE而需要在急诊科短期病房住院治疗的所有年龄在1个月至18岁的患者。

结果

我们分析了190名儿童的数据：新发癫痫发作（N = 118；A组）与已知癫痫患者（N = 72；B组）。156名患者（82.1%）至少进行了一项诊断测试（A组，N = 104，88.1%；B组，N = 52，72.2%；P = 0.05）。在B组中，38例SE患者中有14例检测了抗癫痫药物血药浓度，其中6例剂量不足。治疗方法如下：一线治疗，地西泮（A组80%；B组46%；P < 0.001）；二线治疗，地西泮（A组56%；B组34%；P = 0.02）或氯硝西泮（A组24%；B组46%；P = 0.001）；三线治疗，苯妥英（A组54%；B组22%；P < 0.001）或氯硝西泮（A组18%；B组61%；P < 0.001）。