Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Japan.
Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Japan.
Brain Dev. 2021 Apr;43(4):548-555. doi: 10.1016/j.braindev.2020.11.012. Epub 2020 Dec 17.
Children with either febrile seizure or acute encephalopathy exhibit seizures and/or impaired consciousness accompanied by fever of unknown etiology (SICF). Among children with SICF, we previously reported those who have refractory status epilepticus or prolonged neurological abnormalities with normal AST levels are at a high risk for the development of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), considered to be caused by excitotoxicity. Non-convulsive seizures (NCS) are common in critically ill children and cause excitotoxic neuronal injury. The aim of this study was to elucidate the prevalence of NCS in the acute phase of children at a high risk for developing AESD and the relationship between NCS in the acute phase and neurological outcomes.
We studied 137 children with SICF at a high risk for developing AESD and who underwent continuous electroencephalogram monitoring (cEEG) upon admission to a tertiary pediatric care center at Hyogo Prefectural Kobe Children's Hospital between October 2007 and August 2018. Patient characteristics and outcomes were compared between patients with NCS and without NCS.
Of the 137 children, NCS occurred in 30 children; the first NCS were detected in cEEG at the beginning in 63.3%, during the first hour in 90%, and within 12 h in 96.7%. Neurological sequelae were more common in NCS patients (20.0%) than in non-NCS patients (1.9%; p = 0.001). Five in 30 NCS patients (16.7%) and 3 in 107 non-NCS patients (2.8%) developed AESD (p = 0.013).
The occurrence of NCS is associated with subsequent neurological sequelae, especially the development of AESD.
无论是热性惊厥还是急性脑病的儿童，都表现出发热且病因不明的（SICF）伴发癫痫发作和/或意识障碍。在 SICF 的儿童中，我们之前报道过那些具有难治性癫痫持续状态或伴有正常 AST 水平的延长神经功能异常的儿童，他们具有发展为具有双相癫痫发作和后期弥散减少的急性脑病（AESD）的高风险，被认为是由兴奋性毒性引起的。非惊厥性发作（NCS）在危重病儿童中很常见，会导致兴奋性毒性神经元损伤。本研究的目的是阐明在发生 AESD 高风险的急性期中 NCS 的患病率，以及急性期 NCS 与神经结局之间的关系。
我们研究了 2007 年 10 月至 2018 年 8 月期间在兵库县神户儿童医疗中心的一家三级儿科护理中心住院的 137 名 SICF 发生 AESD 高风险的儿童，他们在入院时接受了连续脑电图监测（cEEG）。比较了有 NCS 和无 NCS 的患者的患者特征和结局。
在 137 名儿童中，30 名儿童出现了 NCS；63.3%的儿童在 cEEG 中首次检测到 NCS，90%的儿童在第 1 小时内检测到，96.7%的儿童在 12 小时内检测到。NCS 患者（20.0%）比非 NCS 患者（1.9%）更常见神经后遗症（p=0.001）。30 名 NCS 患者中有 5 名（16.7%）和 107 名非 NCS 患者中有 3 名（2.8%）发展为 AESD（p=0.013）。
NCS 的发生与随后的神经后遗症有关，特别是 AESD 的发生。
