新生儿急性症状性癫痫后婴儿痉挛的风险。
Risk for infantile spasms after acute symptomatic neonatal seizures.
机构信息
Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
出版信息
Epilepsia. 2020 Dec;61(12):2774-2784. doi: 10.1111/epi.16749. Epub 2020 Nov 13.
OBJECTIVE
Infantile spasms (IS) is a severe epilepsy in early childhood. Early treatment of IS provides the best chance of seizure remission and favorable developmental outcome. We aimed to develop a prediction rule to accurately predict which neonates with acute symptomatic seizures will develop IS.
METHODS
We used data from the Neonatal Seizure Registry, a prospective, multicenter cohort of infants with acute symptomatic neonatal seizures born from July 2015 to March 2018. Neonates with acute symptomatic seizures who received clinical electroencephalography (EEG) and magnetic resonance imaging (MRI) and were younger than 2 years of age at the time of enrollment were included. We evaluated the association of neonatal EEG, MRI, and clinical factors with subsequent IS using bivariate analysis and best subsets logistic regression. We selected a final model through a consensus process that balanced statistical significance with clinical relevance.
RESULTS
IS developed in 12 of 204 infants (6%). Multiple potential predictors were associated with IS, including Apgar scores, EEG features, seizure characteristics, MRI abnormalities, and clinical status at hospital discharge. The final model included three risk factors: (a) severely abnormal EEG or ≥3 days with seizures recorded on EEG, (b) deep gray or brainstem injury on MRI, and (c) abnormal tone on discharge exam. The stratified risk of IS was the following: no factors 0% (0/82, 95% confidence interval [CI] 0%-4%), one or two factors 4% (4/108, 95% CI 1%-9%), and all three factors 57% (8/14, 95% CI 29%-83%).
SIGNIFICANCE
IS risk after acute symptomatic neonatal seizures can be stratified using commonly available clinical data. No child without risk factors, vs >50% of those with all three factors, developed IS. This risk prediction rule may be valuable for clinical counseling as well as for selecting participants for clinical trials to prevent post-neonatal epilepsy. This tailored approach may lead to earlier diagnosis and treatment and improve outcomes for a devastating early life epilepsy.
目的
婴儿痉挛症（IS）是一种儿童早期严重的癫痫。早期治疗 IS 能最大程度地减少癫痫发作并获得良好的发育结局。我们旨在制定一个预测规则，准确预测哪些急性症状性癫痫发作的新生儿会发展为 IS。
方法
我们使用了新生儿癫痫登记处的数据，这是一项前瞻性、多中心队列研究，纳入了 2015 年 7 月至 2018 年 3 月出生的急性症状性新生儿癫痫发作的婴儿。纳入标准为：急性症状性癫痫发作的新生儿接受临床脑电图（EEG）和磁共振成像（MRI）检查，入组时年龄小于 2 岁。我们使用双变量分析和最佳子集逻辑回归评估新生儿 EEG、MRI 和临床因素与后续 IS 的相关性。我们通过平衡统计学意义和临床相关性的共识过程选择最终模型。
结果
204 例婴儿中有 12 例（6%）发展为 IS。多项潜在预测因素与 IS 相关，包括阿普加评分、EEG 特征、癫痫发作特征、MRI 异常和出院时的临床状态。最终模型包括三个危险因素：（a）EEG 严重异常或脑电图记录到≥3 天的癫痫发作，（b）MRI 显示深部灰质或脑干损伤，（c）出院检查时存在异常张力。IS 的分层风险如下：无危险因素为 0%（82 例中 0 例，95%置信区间 [CI] 0%-4%），有一个或两个危险因素为 4%（108 例中 4 例，95% CI 1%-9%），有三个危险因素为 57%（14 例中 8 例，95% CI 29%-83%）。
意义
急性症状性新生儿癫痫发作后，可使用常用的临床数据对 IS 风险进行分层。没有危险因素的患儿无一例发展为 IS，而有三个危险因素的患儿中有>50%发展为 IS。这种风险预测规则可能对临床咨询以及选择预防新生儿后癫痫的临床试验参与者具有重要价值。这种量身定制的方法可能会导致更早的诊断和治疗，并改善这种毁灭性的儿童早期癫痫的结局。
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