Clinical Neurophysiology, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Neurophysiology, Great Ormand Street Hospital for Children, London, UK.
Neuropediatric Unit, Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Epileptic Disord. 2021 Feb 1;23(1):133-142. doi: 10.1684/epd.2021.1251.
To investigate whether it is possible to predict outcome of post-encephalitic epilepsy based on findings during the acute phase of disease. Children (28 days to 17 years) diagnosed with acute encephalitis at Karolinska University Hospital between 2011 and 2016 were included in this study (n=89). They were examined clinically, with repeated electroencephalographic examinations and analysis of cerebrospinal fluid during the acute illness. Thereafter, patients were followed up to 24 months and evaluated for post-encephalitic epilepsy. Variables determined during the acute illness were used to predict the development of post-encephalitic epilepsy: electroencephalographic parameters, cerebrospinal fluid parameters, aetiology and clinical parameters. Fisher's exact test was used to estimate any predictors of epilepsy among the acutely measured parameters. The prevalence of post-encephalitic epilepsy was 9% (n=8) at 24 months. Of these, 3/8 responded to monotherapy with antiepileptic drugs and 5/8 required two or more and 3/8 were medically refractory at 24 months. Presence of acute seizures during admission, epileptic activity on electroencephalographic recordings and new-onset structural lesions demonstrated a significant association with development of post-encephalitic epilepsy (p<0.03) with an odds ratio greater than 5. Using the three above-mentioned parameters, we designed an algorithm to predict cohorts of patients with increased risk of developing post-encephalitic epilepsy. Moreover, patients who developed post-encephalitic epilepsy had a longer duration of hospital admission and longer care in intensive care units in comparison to those who did not. This study demonstrates that the risk of developing post-encephalitic epilepsy was mainly seen among patients with acute seizures, epileptic encephalographic activity in the acute setting or new-onset structural lesions. A simple algorithm could be used to predict the risk of post-encephalitic epilepsy.
探讨是否有可能根据疾病急性期的发现预测脑炎后癫痫的结局。
本研究纳入了 2011 年至 2016 年在卡罗林斯卡大学医院被诊断为急性脑炎的儿童（28 天至 17 岁）（n=89）。他们在急性期接受了临床检查，包括重复脑电图检查和脑脊液分析。此后，对患者进行了 24 个月的随访，并评估了脑炎后癫痫的发生情况。将急性期确定的变量用于预测脑炎后癫痫的发生：脑电图参数、脑脊液参数、病因和临床参数。Fisher 确切检验用于估计急性测量参数中癫痫的任何预测因素。在 24 个月时，脑炎后癫痫的患病率为 9%（n=8）。其中，3/8 例患者对抗癫痫药物单药治疗有反应，5/8 例患者需要两种或更多种药物治疗，3/8 例患者在 24 个月时药物难治。入院时存在急性发作、脑电图记录的癫痫活动和新发结构性病变与脑炎后癫痫的发生显著相关（p<0.03），优势比大于 5。我们使用上述三个参数设计了一种算法来预测发生脑炎后癫痫风险增加的患者队列。此外，与未发生脑炎后癫痫的患者相比，发生脑炎后癫痫的患者的住院时间和重症监护病房的护理时间更长。
本研究表明，发生脑炎后癫痫的风险主要见于急性发作、急性状态下癫痫脑电图活动或新发结构性病变的患者。可以使用简单的算法来预测脑炎后癫痫的风险。
