Rappaport L A, Wypij D, Bellinger D C, Helmers S L, Holmes G L, Barnes P D, Wernovsky G, Kuban K C, Jonas R A, Newburger J W
Department of Medicine, Children's Hospital, Boston, MA 02115, USA.
Circulation. 1998 Mar 3;97(8):773-9. doi: 10.1161/01.cir.97.8.773.
The outcome of infants who have transient seizures after open heart surgery has not been studied. Using the database of the Boston Circulatory Arrest Study involving 171 children with D-transposition of the great arteries, we explored the relationship between early postoperative clinical and EEG seizures and neurodevelopmental outcomes at ages 1 and 2 1/2 years.
At 1 year, children returned for developmental and neurological evaluations and MRI. Parent-completed developmental questionnaires were collected at 2 1/2 years of age. At 1 year, children with early postoperative seizures had lower Psychomotor Development Index (motor function) scores (clinical seizures: 12.9 mean difference [MD]; 95% confidence interval [CI], 2.2 to 23.6; P=.02; EEG seizures: 13.3 MD; 95% CI, 6.8 to 19.7; P<.001). Mental Developmental Index scores of children with clinical or EEG seizures were also lower, but the differences were not statistically significant. Infants with seizures were more likely to have an abnormal neurological examination (clinical seizures: 78% versus 31%; P=.008; EEG seizures: 58% versus 34%; P=.04). Children with EEG seizures were more likely to have MRI abnormalities (43% versus 13%, P=.002). At age 2 1/2, children with EEG seizures had lower scores in several areas of function.
In infants undergoing the arterial switch operation for correction of D-transposition of the great arteries, transient postoperative clinical and EEG seizures were associated with worse neurodevelopmental outcomes at ages 1 and 2 1/2 years as well as neurological and MRI abnormalities at 1 year of age. The occurrence of such seizures may provide an early sign of brain injury with neurological and developmental sequelae.
尚未对接受心脏直视手术后出现短暂性癫痫发作的婴儿的预后进行研究。利用波士顿循环骤停研究数据库，该数据库纳入了171例患有大动脉D型转位的儿童，我们探讨了术后早期临床癫痫发作和脑电图癫痫发作与1岁和2.5岁时神经发育结局之间的关系。
1岁时，儿童返回进行发育和神经学评估以及磁共振成像（MRI）检查。在2.5岁时收集家长填写的发育问卷。1岁时，术后早期癫痫发作的儿童精神运动发育指数（运动功能）得分较低（临床癫痫发作：平均差异[MD]为12.9；95%置信区间[CI]，2.2至23.6；P = 0.02；脑电图癫痫发作：MD为13.3；95% CI，6.8至19.7；P < 0.001）。有临床或脑电图癫痫发作的儿童智力发育指数得分也较低，但差异无统计学意义。癫痫发作的婴儿更有可能神经学检查异常（临床癫痫发作：78%对31%；P = 0.008；脑电图癫痫发作：58%对34%；P = 0.04）。有脑电图癫痫发作的儿童更有可能MRI异常（43%对13%，P = 0.002）。在2.5岁时，有脑电图癫痫发作的儿童在几个功能领域得分较低。
在接受动脉调转术以纠正大动脉D型转位的婴儿中，术后短暂性临床和脑电图癫痫发作与1岁和2.5岁时较差的神经发育结局以及1岁时的神经学和MRI异常有关。此类癫痫发作的发生可能是脑损伤伴有神经学和发育后遗症的早期迹象。
