热性惊厥患儿24 h内惊厥反复发作的危险因素分析

目的探讨热性惊厥患儿24 h内惊厥反复发作的危险因素, 为早期识别有危险因素的患儿并采取干预措施提供临床依据。方法选取2019年6月至2021年6月河北省人民医院儿科收治的384例热性惊厥患儿为研究对象, 分为单次发作组和反复发作组, 回顾性分析两组患儿的临床资料及惊厥反复发作的危险因素。结果 384例热性惊厥患儿, 年龄6个月～5岁, 单次发作组296例, 反复发作组88例, 两组患儿在是否首次发作、首次发作的年龄、发作时体温、发作持续时间≥15 min、热性惊厥家族史及C-反应蛋白这6项指标, 差异均有统计学意义(P均<0.05)。多因素Logistic回归分析发现, 非首次发作(OR=2.085, 95%CI 1.232～3.529, P=0.006)、首次发作年龄小(OR=0.970, 95%CI 0.948～0.993, P=0.010)、发作持续时间≥15 min(OR=3.587, 95%CI 1.497～8.596, P=0.004)、有热性惊厥家族史(OR=1.892, 95%CI 1.126～3.180, P=0.016)是热性惊厥患儿24 h内反复出现惊厥发...     

热性惊厥复发危险因素与预后分析

目的研究热性惊厥患儿的复发危险因素及预后情况.方法结合98例热性惊厥患儿的临床及脑电图资料,研究其复发、转为癫和出现智力障碍及行为异常的情况.结果复发共52例(53.0%),复发危险因素与惊厥家族史、初次发作体温＜38.5℃、初次发作年龄＜1岁及复杂型热性惊厥有关(P＜0.01);热性惊厥转为癫共20例(20.4%),转为癫的危险因素与复杂型热性惊厥、初次发作年龄＜1岁、热性惊厥反复发作有关(P＜0.01);发生智力障碍及行为异常2例(2.0%),说明热性惊厥患儿绝大部分预后较好,智力低下及行为障碍发生率低.结论对有复发危险因素及转为癫危险因素的患儿,应密切随访,采取适当的干预措施.     

幼儿急疹合并热性惊厥的临床特征

目的 探讨幼儿急疹合并热性惊厥的临床特征.方法 回顾性总结本院2005年1月至2008年2月确诊的幼儿急疹病例和热性惊厥病例,对幼儿急疹并热性惊厥的31例患儿的临床资料进行总结,与其他热性惊厥患儿及幼儿急疹未合并热性惊厥者对比,并结合文献进行分析.结果 幼儿急疹合并热性惊厥患儿占所有热性惊厥的17.1%(31/181),占2岁内热性惊厥的24.4%(31/127),占幼儿急疹患儿的15.7%(31/198);幼儿急疹并热性惊厥患儿出现热性惊厥的平均年龄为(0.85 4±0.38)岁,早于一般的热性惊厥患儿(2.41±1.30)岁,P<0.01;与不伴热性惊厥的幼儿急疹患儿比较,伴热性惊厥者的性别、年龄、最高体温、热程、出疹时间均无显著差别(P>0.05),而热性惊厥家族史有显著差别(P<0.05).结论 遗传因素是导致幼儿急疹并热性惊厥发作的一个危险因素;幼儿急疹并热性惊厥时一般预后良好,但要警惕发生严重中枢神经系统损伤的可能性,如癫痫.对于1岁内初次发热并出现热性惊厥的患儿要注意幼儿急疹的可能.     

神经系统及精神疾病

942697热性惊厥患儿复发的多因素分析/刘智胜…//中国实用几科杂志一1994.9(3)一181~182 276例热性惊厥(FC)中,筛选出123例因第l次发作而住院的患儿进行了随访。随访率为86.2%,首次单纯性热惊厥(sFc)者75例,其中有3例后来转为复杂性热惊厥(C Fc);首次发作为cFc者31例。首次Fc患儿年龄较小2个月.最大年龄6岁2个月,77.4%在3岁以内,其中l~2岁占34.0%。在复发的33例中,2岁以内复发者23例,2岁以后复发者10例,其中1~2岁复发占38.9%。就Fc复发的危险因素.根据106例Fc患儿的首次发病年龄、发热至惊厥时间、惊厥发作形式、发作持续时间、同一次热…     

热性惊厥初发时体温和年龄与复发的关系

目的 探讨热性惊厥初次发作时体温高低、开始发热到抽搐的时间及年龄与热性惊厥复发的关系.方法 2004年1月至2006年6月收住我院以热性惊厥起病的192例患儿,根据初次发作时体温的高低将患儿分为3组:体温＞40.0℃组,～40.0℃组,≤38.5℃组；根据开始发热到抽搐的时间分为3组:惊厥发作前发热持续时间≤6 h组,～24 h组,＞24h组；根据年龄分为4组:≤6个月组,～18个月组,～3岁组,＞3岁组.比较各组患儿热性惊厥的复发率及随访情况.结果 所有病例随访至6周岁,失访22例,随访率为88.5％ (170/192).随访的170热性惊厥患儿中,体温＞40.0℃组、～40.0℃组、≤38.5℃组热性惊厥的复发率分别为32.6％ (15/46)、51.1％ (46/90)和79.4％ (27/34),3组复发率比较,差异均有统计学意义(x2=17.18,P＜0.05).惊厥发作前发热持续时间≤6 h组、～24h组、＞24h组复发率分别为70.7％ (29/41)、51.6％ (49/95)和29.4％(10/34),3组复发率比较,差异均有统计学意义(x2=12.71,P ＜0.05).不同初次发作年龄组间热性惊厥的复发率比较[84.6％(22/26) vs63.4％ (45/71) vs 39.5％ (15/38) vs 17.1％ (6/35)],差异均有统计学意义(x2=34.17,P＜0.05).结论 热性惊厥初次发作时年龄越小、体温越低及惊厥发作前发热持续时间越短,热性惊厥复发率越高.     

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目的探讨热性惊厥(FC)继发癫癎(EP)的危险因素,以便早期干预.方法对1988年1月至2000年6月在内蒙古医学院第四附属医院儿科住院的253例FC患儿,进行5年至17年5个月随访观察.以第1次FC发作住院为随访起点,再次住院或家庭访问为随访方式,观察FC患儿继发EP的年发生率.并对FC患儿的发作持续时间、发作总次数、发作体温、首次发作24h内的发作次数、初发年龄、惊厥家族史、发作形式、首次发作48h内的脑电图、性别、原发病等可能继发EP的危险因素详细观察记录.所得资料应用生存分析寿命表和生存分析+COX回归作多元回归分析.结果随访253例FC继发EP 19例.5,10,17年继发EP年发生率分别是0.53%,1.69%,8.70%.FC发作持续时间和发作总次数,经分析分别P<0.05和P<0.01,B分别为负值和正值,分别RR<1和RR>1,其95%可信区间内均不包含1;发作形式和惊厥家族史,均P<0.01,B均为正值,均RR>1,其95%可信区间内均不包含1.结论 FC的发作持续时间长、发作总次数增多、局灶性发作及有惊厥家族史是继发EP的危险因素.     

高热惊厥202例

目的研究高热惊厥(FC)患儿的临床特征及预后,以减少癫和智力低下的发生。方法回顾分析202例FC患儿的临床资料,包括发病年龄特征、与发热的关系、惊厥类型、基础疾病、治疗、惊厥发作次数及复发、家族史。结果202例中首次发作年龄6个月~5岁占90.1%,其中1~3岁占61.9%;79.2%首次发作体温≥38.5℃;多为阵挛性惊厥,96.5%惊厥持续<15 min。其基础疾病以急性上呼吸道感染为主,大多预后良好,仅有少数转为癫。结论FC多发生于6个月~5岁患儿,预后多良好,其防治在于控制惊厥,积极降温,必要时预防性使用抗惊厥药物。     

婴儿严重肌阵挛癫痫的临床特征和基因突变分析

目的 探讨婴儿严重肌阵挛癫癎(SMEI)的临床特点和基因诊断.方法分析13例SMEI患儿的临床和脑电图(EEG)特点及钠离子通道SCN1A基因突变筛查结果.结果男10例,女3例.8例有热性惊厥和癫痫家族史.惊厥起病年龄2～9个月,平均5.6个月.首次发作为热性惊厥9例.13例在病程早期均以反复发热诱发的全面性或一侧性阵挛或强直阵挛发作为主,其中8例有热性惊厥持续状态.出现无热惊厥的年龄为2～21个月.病程中均出现多种发作类型.发作均有热敏感的特点,诱发因素包括发热、洗热水澡和疫苗接种.起病后出现智力发育落后11例.共济失调5例,锥体束征阳性2例.EEG在1岁前多数正常,1岁后出现全导或局灶放电.头颅MBI检查异常2例.13例均应用多种抗癫痫药治疗,发作均未完全控制.卡马西平和拉莫三嗪使部分患儿发作加重.10例发现有SCN1A基因突变.结论 SMEI的临床特点是:1岁以内起病,首次发作常为热性惊厥;1岁以后出现多种发作形式和智力发育落后;发作具有热敏感的特点;EEG早期正常,以后出现全导或局灶放电.筛查SCN1A基因突变有助于早期明确诊断,指导选择抗癫癎药物.     

神经系统及精神疾病

052343复杂型小儿高热惊厥转化为癫痫的影响因素分析/孔德庆…//第三军医大学学报.-2005,27(8).-767～769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(19.25%),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。表2参9(原文摘要)     

神经系统及精神疾病

063775热性惊厥复发危险因素探讨/张喜芳…∥中国实用神经疾病杂志.-2006,9(4).-97~98通过对102例热性惊厥患儿的临床资料进行分析,研究其复发的危险因素。结果:复发48例,占47.06%,复发危险因素与惊厥家庭史、初发病年龄<1岁、惊厥时体温<38.5℃、复杂型热性惊厥有关(P<0.05)。     

Occult bacteremia in children with simple febrile seizures

The controversy surrounding the diagnostic workup for simple febrile seizures has centered around the lumbar puncture. This focus has obscured the potential importance of other tests. A retrospective study was performed to determine the frequency of occult bacteremia in simple febrile seizures. In a pediatric emergency department, we identified 115 cases of simple febrile seizures in children treated as outpatients. Blood cultures were performed in 93 (81%) of 115 patients; five (5.4%) were positive. Children were less likely to have blood cultures performed if they were older than 24 months or had a medical history of simple febrile seizures. However, neither age nor history of febrile seizures affected the risk of bacteremia. These data suggest that patients with simple febrile seizures are at approximately the same risk for bacteremia as children with fever alone. Patients with simple febrile seizures should be treated in the same manner as other patients of the same age with regard to the performance of blood cultures.     

Predictors of febrile seizure: a matched case-control study

In a prospective matched case-control study carried out to determine risk factors of febrile seizures among children in the United Arab Emirates, 84 patients with febrile seizure were identified and were matched with 84 control febrile patients without seizure in the same age range, who attended the same hospital during the same period of time. Logistic regression analysis showed that the age at first seizure, family history of febrile seizure, duration of fever, and height of temperature were the only significant predictors for febrile seizures.     

Family history and recurrence of febrile seizures.

To determine the value of a detailed family history for the assessment of the risk of recurrence of febrile seizures, 115 children who visited the emergency room of an academic children's hospital were studied prospectively. The recurrence risk of febrile seizures was analysed in relation to the child's family history and the proportion of relatives affected by febrile seizures using Kaplan-Meier estimates and Cox proportional hazard models. A first degree family history positive for febrile seizures (parents or siblings affected by febrile seizures) increased a child's two year recurrence risk from 27 to 52%. No significant increase of recurrence risk for febrile seizures was found in children with second degree relatives (grandparents and uncles/aunts) or cousins only affected by febrile seizures. Recurrence risk was significantly correlated with the proportion of first degree relatives affected by febrile seizures: risks were 27, 40, and 83% in children whose proportion was 0, 0-0.5, and > or = 0.5 respectively. Analysis of the recurrence risk in relation to a weighted proportion, adjusted for the attained age and sex of first degree relatives, showed similar results. It is concluded that the application of the proportion of first degree relatives affected by febrile seizures generates a more differentiated assessment of the recurrence risk of febrile seizures.     

Family history and recurrence of febrile seizures

To determine the value of a detailed family history for the assessment of the risk of recurrence of febrile seizures, 115 children who visited the emergency room of an academic children's hospital were studied prospectively. The recurrence risk of febrile seizures was analysed in relation to the child's family history and the proportion of relatives affected by febrile seizures using Kaplan-Meier estimates and Cox proportional hazard models. A first degree family history positive for febrile seizures (parents or siblings affected by febrile seizures) increased a child's two year recurrence risk from 27 to 52%. No significant increase of recurrence risk for febrile seizures was found in children with second degree relatives (grandparents and uncles/aunts) or cousins only affected by febrile seizures. Recurrence risk was significantly correlated with the proportion of first degree relatives affected by febrile seizures: risks were 27, 40, and 83% in children whose proportion was 0, 0-0.5, and > or = 0.5 respectively. Analysis of the recurrence risk in relation to a weighted proportion, adjusted for the attained age and sex of first degree relatives, showed similar results. It is concluded that the application of the proportion of first degree relatives affected by febrile seizures generates a more differentiated assessment of the recurrence risk of febrile seizures.     

Febrile status epilepticus

As part of a study of status epilepticus in children (Maytal J, Shinnar S, Moshe SL, Alvarez LA. Pediatrics. 1989; 83:323-331); 44 children with febrile convulsions lasting more than 30 minutes were followed for a mean of 28 months (range 4 to 72). Thirty children were followed prospectively. Children with prior afebrile seizures or evidence of acute central nervous system infection were excluded. Nine (20%) children had prior neurological deficits. The duration of the febrile seizure was 0.5 to 1 hour in 41 cases (85%), 1 to 2 hours in 5 (10%), and greater than 2 hours in 2 children (5%). No child died or developed new neurological deficits following the seizures. The risk of recurrent seizures was increased, but only in the group with prior neurological abnormality. Six (66%) of these children had subsequent febrile seizures compared with 12 (34%) of the normal children (P = .08). Three (33%) had recurrent febrile status epilepticus compared with only 1 (3%) normal child (P = .023). The 2 children in the prospective arm of the study with recurrent febrile status epilepticus were both neurologically abnormal (P = .035). All 3 of the children who subsequently had afebrile seizures (2 prospective) were neurologically abnormal (P = .006 overall, P = .035 for prospective only). It is concluded that the occurrence of febrile status epilepticus in a neurologically impaired child is a risk factor for subsequent febrile as well as afebrile seizures. The occurrence of febrile status epilepticus in an otherwise normal child does not significantly increase the risk for subsequent febrile (brief or prolonged) or afebrile seizures in the first few years following the episode.     

Frequency of fever episodes related to febrile seizure recurrence

The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR) = 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR = 0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure.     

Sudden death in toddlers associated with developmental abnormalities of the hippocampus: a report of five cases.

Sudden unexplained death in childhood (SUDC) is the sudden death of a child older than 1 year of age that remains unexplained after review of the clinical history, circumstances of death, and autopsy with appropriate ancillary testing. We report here 5 cases of SUDC in toddlers that we believe define a new entity associated with hippocampal anomalies at autopsy. All of the toddlers died unexpectedly during the night, apparently during sleep. Within 48 hours before death, 2 toddlers had fever, 3 had a minor upper respiratory tract infection, and 3 experienced minor head trauma. There was a history of febrile seizures in 2 (40%) and a family history of febrile seizures in 2 (40%). Hippocampal findings included external asymmetry and 2 or more microdysgenetic features. The incidence of certain microdysgenetic features was substantially increased in the temporal lobes of these 5 cases compared with the temporal lobes of 39 (control) toddlers with the causes of death established at autopsy (P < 0.01). We propose that these 5 cases define a potential subset of SUDC whose sudden death is caused by an unwitnessed seizure arising during sleep in the anomalous hippocampus and producing cardiopulmonary arrest. Precipitating factors may be fever, infection, and/or minor head trauma. Suggested risk factors are a history of febrile seizures and/or a family history of febrile seizures. Future studies are needed to confirm these initial findings and to define the putative links between sudden death, hippocampal anomalies, and febrile seizures in toddlers.     

伴高热惊厥史的儿童癫痌病例分析

分析伴高热惊厥史的癫痌患儿的临床特点,探讨高热惊厥脑损伤及其与颞叶癫痌的关系。 方法对1996～1999年本院儿科神经病房480例住院癫痌患儿进行回顾性分析,包括首发年龄、家族史、持续时 间、癫痌发作类型、神经影像学及脑电图改变等。结果115例(23.9％)患儿有前期高热惊厥史。伴高热惊厥史 的患儿癫痌发作早且易于出现癫痌持续状态。与无高热惊厥史的患儿相比,伴高热惊厥史的患儿强直-阵挛发作 较多,复杂部分性发作较少。408例患儿曾行影像学检查,4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史 的癫痌患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫痌患儿。有6.08％(7/115)伴高热惊厥史的癫 痌惠儿和6.84％(25/365)无高热惊厥史的癫痌患儿脑电图表现为单纯颞叶异常放电,二组相比无明显差异。结论 在癫痌患儿中,高热惊厥可能伴有脑损伤,且可能与后期的癫痌发生有关,伴高热惊厥史者不一定发展为颞叶癫痌。