儿童首次无热惊厥后癫痫复发的风险：一项长期随访研究

The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up.

作者信息

Shinnar S, Berg A T, Moshe S L, O'Dell C, Alemany M, Newstein D, Kang H, Goldensohn E S, Hauser W A

机构信息

Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.

出版信息

Pediatrics. 1996 Aug;98(2 Pt 1):216-25.

PMID:8692621

Abstract

OBJECTIVE

To assess the long-term recurrence risks after a first unprovoked seizure in childhood.

METHODS

In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure.

RESULTS

One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%, 37%, 42%, and 44% at 1, 2, 5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence.

CONCLUSIONS

The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

摘要

目的

评估儿童首次无诱因癫痫发作后的长期复发风险。

方法

在一项前瞻性研究中，407名首次出现无诱因癫痫发作的儿童自首次发作起平均随访6.3年。

结果

171名儿童（42%）随后出现癫痫复发。癫痫复发的累积风险在1年、2年、5年和8年时分别为29%、37%、42%和44%。复发的中位时间为5.7个月，53%的复发发生在6个月内，69%在1年内，88%在2年内。仅5例复发（3%）发生在5年后。多变量分析显示，癫痫复发的危险因素包括既往有症状性病因、脑电图（EEG）异常、睡眠中发作、既往热性惊厥史以及陶德麻痹。在隐源性病例中，危险因素为EEG异常和睡眠中首次发作。在既往有症状性病例中，危险因素为既往热性惊厥史和发病年龄小于3岁。总体组中晚期复发（2年后）的危险因素为病因、EEG异常和既往热性惊厥史，隐源性组为EEG异常。这些与早期复发的危险因素相似。