Ohno Atsuko, Okumura Akihisa, Fukasawa Tatsuya, Nakata Tomohiko, Suzuki Motomasa, Tanaka Masaharu, Okai Yu, Ito Yuji, Yamamoto Hiroyuki, Tsuji Takeshi, Kidokoro Hiroyuki, Saitoh Shinji, Natsume Jun
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Department of Pediatrics, Aichi Medical University, Aichi, Japan.
Brain Dev. 2022 Mar;44(3):221-228. doi: 10.1016/j.braindev.2021.11.003. Epub 2021 Dec 4.
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common type of acute encephalopathy in Japan; the condition is clinically characterized by prolonged seizures as the initial neurological symptom, followed by late seizures 4-6 days later. It is difficult to differentiate AESD from prolonged febrile seizures (PFSs). Here, we explored the use of electroencephalography to differentiate AESD from PFSs.
We studied the electroencephalograms (EEGs) of children <6 years of age diagnosed with AESD or PFSs; all EEGs were recorded within 48 h of seizure onset (i.e., before the late seizures of AESD). Two pediatric neurologists evaluated all EEGs, focusing on the basic rhythm, slowing during wakefulness/arousal by stimuli, spindles, fast waves, and slowing during sleep.
The EEGs of 14 children with AESD and 31 children with PFSs were evaluated. Spindles were more commonly reduced or absent in children with AESD than in those with PFSs (71% vs. 31%, p = 0.021). Fast waves were also more commonly reduced or absent in children with AESD (21% vs. 0%, p = 0.030). The rates of all types of slowing did not differ between children with AESD and those with PFSs, but continuous or frequent slowing during sleep was more common in the former (50% vs. 17%, p = 0.035).
EEG findings may usefully differentiate AESD from PFSs. Reduced or absent spindles/fast waves and continuous or frequent slowing during sleep are suggestive of AESD in children with prolonged seizures associated with fever.
伴有双相性癫痫发作和晚期弥散受限的急性脑病（AESD）是日本常见的急性脑病类型；该病症的临床特征为最初的神经症状是癫痫持续发作，随后在4 - 6天后出现晚期癫痫发作。将AESD与热性惊厥持续状态（PFSs）区分开来很困难。在此，我们探讨了利用脑电图来区分AESD和PFSs。
我们研究了诊断为AESD或PFSs的6岁以下儿童的脑电图（EEGs）；所有脑电图均在癫痫发作开始后的48小时内记录（即AESD晚期癫痫发作之前）。两名儿科神经科医生评估了所有脑电图，重点关注基本节律、刺激引起的清醒/觉醒期慢波、纺锤波、快波以及睡眠期慢波。
评估了14例AESD患儿和31例PFSs患儿的脑电图。与PFSs患儿相比，AESD患儿的纺锤波更常减少或缺失（71%对31%，p = 0.021）。AESD患儿的快波也更常减少或缺失（21%对0%，p = 0.030）。AESD患儿和PFSs患儿各种类型慢波的发生率没有差异，但睡眠期持续或频繁出现慢波在前者中更常见（50%对17%，p = 0.035）。
脑电图结果可能有助于区分AESD和PFSs。纺锤波/快波减少或缺失以及睡眠期持续或频繁出现慢波提示伴有发热的癫痫持续发作患儿患有AESD。
