小儿热性惊厥预后影响因素分析

目的分析小儿热性惊厥复发、转为癫痫、出现脑损伤的影响因素。方法根据169例热性惊厥患儿初发年龄、缺铁性贫血、发作时体温、惊厥分型、持续时间、围产期异常、脑电图、惊厥家族史等临床资料及随访情况,对复发、转为癫痫、出现脑损伤的影响因素分别进行单因素分析和Logistic回归分析。结果复发的危险因素有：初发年龄〈1岁、SFC、惊厥家族史;转为癫痫的危险因素有：惊厥≥2次、持续≥15min、SFC;出现脑损伤的的危险因素有：持续≥15min、SFC。结论对热性惊厥患儿应密切随访,采取积极的防治措施。     

Febrile convulsion--an overview

Febrile convulsion is the most frequently occurring epilepsy syndrome, experienced in infants/children between 6 months and 5 years of age associated with fever >38 degrees C. Children having first or second degree relative with history of febrile convulsion, neonatal nursery stay of more than 30 days, developmental delay or attendance at day care centre are at increased risk of developing febrile convulsion. Single febrile convulsion does not increase the risk of epilepsy and there is no causal relationship between febrile convulsion and subsequent epilepsy. It has been recognised that there is significant genetic component for susceptibility to febrile seizures. To make the diagnosis of febrile convulsion, meningitis, encephalitis, serious electrolyte imbalance and other acute neurologic illnesses are to be excluded. While managing acute attack the steps to be taken are--airway management, a semi-prone position to avoid aspiration, monitoring vital signs and other supportive care. Diazepam or lorazepam is the drug to be used. There is no reason to expect phenobarbitone administered at the time of fever to be effective in prevention of febrile convulsion. The parents should be counselled about the benign nature of the convulsion. Although the febrile convulsion a frightening event, still it is a benign condition.     

复杂型小儿高热惊厥转化为癫痫的影响因素分析

目的探讨复杂型小儿高热惊厥转变为癫痫的影响因素.方法对162例复杂型高热惊厥患儿的临床资料,进行调查及回顾性分析.结果162例患儿发展为癫痫的共32例(19.75%),其中有癫痫家族史的35例,转化为癫痫的15例(42.86%);有影响神经系统发育因素的55例,转化为癫痫20例(36.36%);发热距惊厥发作的时间越短转化为癫痫的比例越高.结论有癫痫家族史及有影响神经系统发育因素的、发热与出现惊厥的间隔时间均为复杂型高热惊厥发展成癫痫的重要因素.     

小儿热性惊厥的诊治进展

热性惊厥(FS)是小儿时期最为常见的惊厥原因,主要见于婴幼儿时期(6个月至3岁)。惊厥大多发生在发热性疾病的初期,70%的FS发病与上呼吸道感染有关,少数伴发于中耳炎、胃肠道感染或出疹性疾病初期。但小儿FS不包括由颅内疾病引起的发热惊厥。因而,对小儿FS的诊治进行深入研究可进一步防治该病的发生、发展,进而提高患儿的生活质量。该文就FS的病因、诊断、治疗及全面性癫痫伴FS附加症进行综述。     

急诊儿童惊厥138例的鉴别诊断及临床分析

目的 对小儿惊厥的临床特点进行分析,以指导治疗和预后. 方法 对138例急诊惊厥患儿临床特点进行回顾性分析. 结果 138例患儿中,全身性强直-阵挛发作56例,肌阵挛19例,失神1例,局限性发作41例;一次发作者101例,丛集性发作37例;伴有发热者92例,无热惊厥46例.病因前3位为热性惊厥59例（42.75％）,癫痫24例（17.39％）,颅内感染15例（10.87％）. 结论 小儿惊厥的主要病因为热性惊厥,其次为癫痫、颅内感染.积极对因治疗可改善预后.     

小儿惊厥172例临床分析

[背景]探讨小儿惊厥的病因及临床特点,有效控制小儿惊厥发作.[病例报告]对172例有惊厥表现患儿的临床资料进行回顾性分析,其中有热惊厥为103例(59.9%),其病因以感染所致热性惊厥为主;无热惊厥为69例(40.1%),其病因复杂,以癫痫、腹泻相关性良性惊厥及缺氧缺血性脑病等为常见.[讨论]引起小儿惊厥的病因比较复杂,高热惊厥为小儿惊厥的第一大病因,年龄多在6个月³岁;其次为电解质紊乱所致惊厥,年龄在2岁以内多见;颅内出血、缺氧缺血性脑病所致惊厥多见于新生儿;颅内感染、癫痫所致惊厥多见于学龄期儿童.     

首次热性惊厥与人疱疹病毒6型感染的关系

目的探讨首次热性惊厥与人疱疹病毒6型（HHV-6）感染的关系及其临床特征。方法采用PCR技术对75名首次发生热性惊厥的患儿进行HHV 6检测，并对比患儿HHV-6感染与否的临床特征。结果75名首次热性惊厥患儿中有26人感染HHV-6，感染 HHV-6患儿的平均年龄明显低于未感染者（P＜0.01）。首次热性惊厥合并HHV-6感染患儿丛集性发作、持续性发作、部分性发作、和发作后麻痹出现的频率明显高于未感染者（P＜0.05）。小于1岁的感染HHV-6的首次热性惊厥患儿非典型发作出现的频率明显高于同年龄组的未感染患儿（P＜0.05）。结论HHV-6感染与婴幼儿首次热性惊厥发作密切相关，可导致更严重惊厥形式的产生，并可能是继发性癫痫发生的一个危险因素。     

惊厥性疾病患儿血浆和脑脊液中神经肽Y、脑源性神经营养因子、白介素-6的水平变化及相关性研究

目的:探讨惊厥性疾病患儿血浆和脑脊液中神经肽Y(NPY)、脑源性神经营养因子(BD-NF)、白介素-6(IL-6)的水平变化及相互关系。方法:选取惊厥性疾病患儿74例,分别在入院第1天、第7天采取静脉血,第7天采取脑脊液(CSF)标本,采用放射免疫分析方法检测血浆和CSF中NPY、BDNF、IL-6的水平。结果:惊厥组(热惊厥、癫痫)患儿惊厥发作后血浆、CSF中NPY、Il-6水平均增高,BDNF降低,但三者第7天较第1天增高;血浆、CSF中NPY、BDNF在不同热惊厥发作和癫痫发作中无差异,但IL-6在不同热惊厥发作和癫痫发作中有差异;血浆、CSF中NPY、IL-6与惊厥中发作次数有关,BDNF与惊厥中发作次数无关;血浆与CSF中的NPY、BDNF、IL-6均分别呈正相关,血浆和CSF中的NPY与IL-6呈正相关,与BDNF呈负相关;BDNF与IL-6呈负相关。结论惊厥性疾病患儿血浆、CSF中NPY、Il-6水平均增高,与惊厥发作次数有关,在惊厥发生的不同阶段水平不同;血浆与CSF中NPY、BDNF、IL-6水平均分别呈正相关,血浆中的水平能间接反映CSF水平;血浆和CSF中的NPY与IL-6呈正相关,与BDNF呈负相关;BDNF与IL-6呈负相关。     

检测热性惊厥患儿CK-MB和肌钙蛋白Ⅰ的临床意义

目的探讨热性惊厥患儿抽搐后肌酸激酶同工酶（CK-MB）及肌钙蛋白Ⅰ（cTnI）的变化及抽搐时间的不同对心肌损害的影响。方法将246例热性惊厥患儿根据抽搐时间分为A组188例和B组58例,分别进行CK-MB及cTnI检测,比较两组患儿的CK-MB及cTnI阳性率。结果两组热性惊厥患儿CK-MB和cTnI均有不同程度的改变,且抽搐时间越长,CK-MB和/或cTnI阳性率越高。两组热性惊厥患儿的CK-MB和cTnI阳性率有统计学差异（P〈0.05）。结论热性惊厥可引起患儿心肌损害,抽搐时间越长心肌损害越明显。治疗时要注意保护心肌,以减少并发症的发生。     

24小时动态脑电图对小儿非癫痫性发作性疾病的诊断价值

目的：提高临床医师对小儿非癫痫性发作性疾病的认识。方法：对2009年1月～2010年8月我院就诊的299例年龄在49d～5岁之间拟诊或需排除癫痫的患儿进行动态脑电图（AEEG）监测,依据国际抗癫痫联盟（ILAE）关于癫痫和癫痫综合征的分类标准,分为非癫痫性发作性疾病150例,癫痫125例,热性惊厥24例。结果：299例中非癫痫性发作性疾病150例,其中主要为非癫痫性强直样发作、睡眠肌阵挛、脑发育不良及脑损伤引起的发作性抖动、小儿屏气发作、心因性发作、触觉或情绪诱发性运动障碍、电解质紊乱、晕厥、小儿夜惊等;AEEG监测到发作间期正常99例,癫痫样放电37例,非特异性改变14例;同期监测到60例有临床发作的病例均不伴异常放电。结论：动态脑电图能有效地诊断非癫痫性发作,可提高临床医师对该疾病的认识。     

Febrile seizures in young children: role of fluid intake and conservation.

Febrile seizures are a common occurrence in young children with incidence rates varying from 3-14%, depending on the geographic region. Studies have suggested that an elevated temperature is a factor in their development, though other factors may synergistically lower the seizure threshold. While it is recognized that excessive or rapid dilute fluid intake can cause seizures in young children, and in adults during strenuous physical activity, less focus has been paid to its involvement during febrile illnesses. Young children are more vulnerable to the development of febrile seizures due to their small skull size relative to brain volume. In animals, reduced serum sodium levels have been shown to lower the threshold to convulsive stimuli, while hypertonic saline has been shown to rapidly reverse these effects. Similarly vasopressin, frequently elevated during acute infections, enhances fluid retention and may also be a precipitating factor for febrile seizures. Although an elevated temperature may augment seizure risk, antipyretics have not been shown to prevent them. In fact, some may increase seizure risk through a reduction in urine output. It has long been observed that fluid retention occurs during febrile infections, followed by diuresis during convalescence. This characteristic observation led to recommendations for restricted fluid intake during acute infections dating back more than 2,000 years. Only recently has there been a return to restricted fluid intake for patients with potentially reduced free water excretion. Further studies are required to determine the role of the overall fluid balance in the etiology of childhood febrile seizures.     

热性惊厥患儿60例临床分析

目的:探讨儿童热性惊厥(FC)的临床特点。方法:对60例FC患儿临床资料进行回顾性分析。结果:60例FC患儿首发中有83.33%在3岁以下,男多于女,36.67%患儿有惊厥家族史;复发率为33.33%,癫痫发生率为3.33%;智力低下为1.67%。行为异常SFC为17.5%,CFC为55%。结论:FC的远期预后良好,若无特殊情况无需药物预防。     

Multifacctorial origin and clinical presentations of epilepsy in west Bengal

Epilepsy is a brain dysfunction characterised by unpredictable occurrence of seizures. There are various causes and presentations of epilepsy but in many cases no definite cause is found. In the present work an effort has been made to search different causes and presentations of epilepsy in West Bengal. In this respect 66 subjects of different age groups suffering from epilepsy were chosen during a period of 1 1/2 years (June 2003 to November 2004). They were closely followed with thorough history taking, clinical examination and relevant investigations. Partial seizures comparised 57.6% cases whereas generalised seizure accounted for rest 42.4% cases. Idiopathic epilepsy was found to be highest in number (59.0%) followed by infective (15.2%) and and post-traumatic (7.6%). Positive family history was obtained in 35.9% cases, history of birth asphyxia in 25.6% cases and history of febrile convulsion in 20.5% cases of idiopathic epilepsy. In a certain percentage of idiopathic cases various psychosocial factors were found to be associated with epilepsy.     

热性惊厥儿童血清BDNF水平及其与动态脑电图联合应用的价值

［摘要］ 目的 探讨血清脑源性神经营养因子（brain derived neurotrophie factor，BDNF）在儿童发热惊厥中的表达及其与动态脑电图（ambulatory electroencephalogram，AEEG）联合应用的价值，为临床诊断和治疗提供可靠依据。 方法 选取发热惊厥患儿100例和同期体检的健康儿童50例，检测并分析所有入选者血清BDNF水平及动态脑电波。 结果 单纯性发热惊厥组和复杂性发热惊厥组血清BDNF水平显著高于对照组，复杂性发热惊厥组显著高于单纯性发热惊厥组（P＜0.05）。复杂性发热惊厥组脑电图异常发生率显著高于单纯性发热惊厥组（P＜0.05），但2组脑电图异常时相、部位分布差异无统计学意义（P＞0.05）。1年内，复杂性发热惊厥组癫痫发生率显著高于单纯性发热惊厥组（P＜0.05）。BDNF+AEEG诊断发热惊厥的特异度显著高于BDNF、AEEG（P＜0.05）。ROC曲线显示，BDNF+AEEG诊断发热惊厥的曲线下面积显著大于BDNF、AEEG（P＜0.05）。 结论 血清BDNF表达水平和AEEG联合应用对发热惊厥儿童的临床诊断和治疗具有一定价值，值得临床推广应用。     

免疫球蛋白与热性惊厥复发相关性的临床研究

目的研究热性惊厥患儿体内免疫球蛋白的水平,以确定热性惊厥与免疫球蛋白的相关性。方法分组检测热性惊厥患儿及对照组的高热非惊厥患儿血IgG、IgM、IgA数值,并进行统计学处理。结果热性惊厥首发组血清IgG、IgA明显低于对照组,差异有显著性意义(P<0.05);热性惊厥复发组血清IgG、IgA明显低于对照组,差异有极显著性意义(P<0.01);热性惊厥复发组血清IgG、IgA明显低于热性惊厥首发组,差异有显著性意义(P<0.05);热性惊厥首发及复发组血清IgM值与对照组比较无显著差异(P>0.05)。结论体液免疫功能异常与热性惊厥发病密切相关,不仅是热性惊厥发病的主要病因之一,而且可能是复发的高危因素之一。     

FC患儿发病年龄、发作次数及脑电图与预后的关系

目的 探讨热性惊厥(FC)患儿的发作年龄、发作次数与预后的关系.方法 对146例FC患儿的发病年龄、发作次数、24h动态脑电图和3年随访结果进行回顾性分析.结果 在 146例FC患儿中,总异常率为30.1%,在异常脑电图中,非特异性异常22.6%,特异性异常7.5%;分组比较,性别之间差异无显著性(X2=2.33,P>0.05);≥3岁组和<3岁组AEEG总异常率分别为14.7%和46.5%,差异有显著性(X2=-18.29,P<0.01);反复发作组明显高于首发组(x 2=-23.87,P<0.01)、有家族史组明显高于无家族史组(X2=-10.18,P<0.01).非特异性异常组脑电图组的患儿1-3年随访痊愈率分别51.7%(15/29)、69.O%(20/29)和82.8%(24/29);特异性异常组分别为10.0%(1/10)、20.0%(2/10)和40.0%(4/10).非特异性异常的患儿其预后明显优于特异性异常的患儿,两者比较差异有显著性(P<0.05).结论 FC患儿的预后与发病年龄、发作次数和家族史有密切关系.     

小儿高热惊厥60例急救与治疗体会

目的探讨小儿高热惊厥的临床治疗及预防措施。方法 60例高热惊厥患儿给予吸氧、退热等急救处理,采用地西泮控制惊厥,苯巴比妥预防惊厥复发,静脉穿刺困难者,应用5%水合氯醛联合地西泮、对乙酰氨基酚灌肠。结果 60例患儿经急救处理均治愈出院,无1例死亡。结论及时有效地控制惊厥,加强综合护理是治疗小儿高热惊厥的关键。     

轻度胃肠炎伴婴幼儿良性惊厥31例临床分析

目的: 探讨轻度胃肠炎伴婴幼儿良性惊厥(BICE)的临床特点及预后。方法: 分析2001年11月~2006年10月轻度胃肠炎伴发无热惊厥31例患儿的临床和随访资料。结果: 31例均为5~25个月的婴幼儿,12~24个月22例;均发生在秋、冬季;3天内发生惊厥29例,1次病程中惊厥平均发作1.4次,表现为全身强直-阵挛发作,发作间期脑电图仅1例呈4~5Hzθ波活动,其余脑电图均正常;脑影像学、血生化及脑脊液检查正常,惊厥停止后未行抗治疗。1例复发,复发≤ 2次,病程少于1年。全部病例无癫和热性惊厥家族史,精神运动发育正常。结论: 轻度胃肠炎可以伴有无热惊厥,均发生在婴幼儿,多数为一过性,不需特殊治疗,预后良好。     

小儿惊厥的临床特点及治疗分析

目的探讨小儿惊厥的临床特点及治疗体会。方法将我院儿科的惊厥患儿共128例作为研究对象,根据临床特点给予相关治疗。短暂热性惊厥患儿给予物理降温,酌情选用口服布洛芬,惊厥时给予安定静注;简单性热性惊厥患儿采用问歇服药法,反复发作或单次持续时间超过5min以上的患儿,使用甘露醇脱水,同时查找病因,给予病因治疗和支持治疗;复杂性热性惊厥患儿在上述基础上,采用长期药物维持治疗,如苯巴比妥、扑痫酮、丙戊酸钠和卡马西平等。结果128例惊厥患儿均治疗有效。除复杂性高热惊厥和无热惊厥患儿各有1例发展成为癫痫,其他患儿均无明显的后遗症。结论小儿惊厥的发病因素较为复杂,但除去先天性或外伤性因素外,一般预后较好。惊厥复发频率与发育程度有关,应该在治疗有效的基础上,避免诱发因素,降低复发率,使之能尽量顺利成长,顺利度过惊厥危险期。