Jongruk Piyatida, Wiwattanadittakul Natrujee, Katanyuwong Kamornwan, Sanguansermsri Chinnuwat
Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand.
Neurology Division, Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand.
Pediatr Int. 2022 Jan;64(1):e14926. doi: 10.1111/ped.14926.
Febrile seizures are the most common seizures in children. Children with complex febrile seizures have a higher risk of subsequent epilepsy compared with children with simple febrile seizures. Multiple risks factors for epilepsy, including focal status epilepticus, family history of epilepsy, neurodevelopmental abnormalities and abnormal electroencephalogram findings, have been found with inconsistent results. The aim of this study is to identify risk factors for developing epilepsy in children with complex febrile seizures.
The study included 248 children aged 3-72-months, diagnosed with complex febrile seizures at Chiang Mai University Hospital. Demographic data, seizure characteristics, electroencephalogram and neuroimaging findings were identified, and assessed to establish whether they were risk factors for subsequent epilepsy.
Fifty-five patients (22.1%) had subsequent epilepsy. Using Cox regression-survival analysis, factors associated with epilepsy were prolonged seizures >15 min (P = 0.006; Hazard Ratio (HR): 2.475; 95% Confidence Interval (CI): 1.294-4.735), developmental delay (P = 0.019; HR: 4.476; 95% CI: 2.280-15.646), epileptiform discharges on electroencephalogram (P = 0.023; HR: 1.391; 95%CI: 1.174-1.876), and abnormal neuroimaging (computed tomography or magnetic resonance imaging; P = 0.028; HR: 1.355; 95% CI: 1.034-1.776). Age at onset, peak febrile temperature, duration between the onset of fever and the occurrence of seizure, recurrent seizures within 24 h, focal seizures, abnormal neurological exams and family history of febrile seizure or epilepsy were not associated with increased risk of subsequent epilepsy in this study.
Risk factors associated with increased risk of epilepsy in children with complex febrile seizures are prolonged seizures or febrile status epilepticus, developmental delay, electroencephalogram epileptiform discharges, and abnormal neuroimaging. Their presence would merit close clinical monitoring.
热性惊厥是儿童最常见的惊厥类型。与单纯热性惊厥儿童相比，复杂性热性惊厥儿童随后发生癫痫的风险更高。已发现多种癫痫风险因素，包括局灶性癫痫持续状态、癫痫家族史、神经发育异常和脑电图异常结果，但结果并不一致。本研究的目的是确定复杂性热性惊厥儿童发生癫痫的风险因素。
该研究纳入了248名年龄在3至72个月之间、在清迈大学医院被诊断为复杂性热性惊厥的儿童。确定了人口统计学数据、惊厥特征、脑电图和神经影像学检查结果，并进行评估以确定它们是否为随后发生癫痫的风险因素。
55名患者（22.1%）随后发生了癫痫。使用Cox回归生存分析，与癫痫相关的因素包括惊厥持续时间>15分钟（P = 0.006；风险比（HR）：2.475；95%置信区间（CI）：1.294 - 4.735）、发育迟缓（P = 0.019；HR：4.476；95% CI：2.280 - 15.646）、脑电图癫痫样放电（P = 0.023；HR：1.391；95% CI：1.174 - 1.876）以及神经影像学异常（计算机断层扫描或磁共振成像；P = 0.028；HR：1.355；95% CI：1.034 - 1.776）。在本研究中，发病年龄、发热峰值温度、发热开始至惊厥发生的持续时间、24小时内反复惊厥、局灶性惊厥、神经系统检查异常以及热性惊厥或癫痫家族史与随后发生癫痫的风险增加无关。
与复杂性热性惊厥儿童癫痫风险增加相关的风险因素是惊厥持续时间延长或热性癫痫持续状态、发育迟缓、脑电图癫痫样放电以及神经影像学异常。这些因素的存在值得密切临床监测。
