PDF(Pubmed)
Abstract：
OBJECTIVE: To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure.
METHODS: Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality.
RESULTS: Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence.
CONCLUSIONS: Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures.
CONCLUSIONS: This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.
METHODS: Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality.
RESULTS: Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence.
CONCLUSIONS: Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures.
CONCLUSIONS: This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.
摘要：
目的：为了确定长期结果，包括死亡率和反复发作,在艾滋病毒携带者（CLWH）出现新发癫痫的儿童中。
方法：前瞻性地纳入了赞比亚CLWH和新发作性癫痫发作，以确定反复发作的风险和危险因素。人口统计数据,临床资料,索引性癫痫病因，以前报道了30日死亡率结局.放电后,每季度对儿童进行随访,以确定反复发作和死亡.鉴于早期死亡的高风险，本研究使用校正了死亡率的模型评估了反复发作的危险因素.
结果：在73名注册儿童中，28人死亡（38%），22在指数发作后30天内。中位随访时间为533天（IQR18-957），有5％（4/73）的随访失败。整个队列中癫痫发作复发率为19%。在癫痫发作后至少30天存活的儿童中，27%有反复发作。从初次发作到反复发作的中位时间为161天（IQR86-269）。中枢神经系统机会性感染（CNSOI），由于指示性癫痫发作的原因是对复发性癫痫发作具有保护性,而较高的功能状态是癫痫发作复发的危险因素.
结论：在出现新发作癫痫的CLWH中，在急性疾病期之后,死亡风险仍然升高.反复发作是常见的，即使在调整死亡结果后，功能水平较高的儿童也更有可能发作。为了照顾这些儿童，需要适合与抗逆转录病毒疗法共同使用的新型抗癫痫药物。CNSOI可能代表索引癫痫发作的潜在可逆挑衅，而无CNSOI的高功能CLWH中的癫痫发作可能是先前脑损伤或与HIV无关的癫痫发作易感性的结果，因此代表了癫痫发作的持续易感性。
结论：这项研究追踪了经历了新发作的癫痫发作的CLWH，以了解有多少人继续发作更多的癫痫发作，并确定与发作更多相关的任何患者特征。研究发现，除了新发作的癫痫发作的急性临床表现外，死亡率仍然很高。中枢神经系统OI导致新发作癫痫发作的儿童有较低的后期癫痫发作风险，可能是因为癫痫发作的诱因可以治疗。相比之下,无CNSOI的高功能儿童未来癫痫发作的风险较高.
方法：前瞻性地纳入了赞比亚CLWH和新发作性癫痫发作，以确定反复发作的风险和危险因素。人口统计数据,临床资料,索引性癫痫病因，以前报道了30日死亡率结局.放电后,每季度对儿童进行随访,以确定反复发作和死亡.鉴于早期死亡的高风险，本研究使用校正了死亡率的模型评估了反复发作的危险因素.
结果：在73名注册儿童中，28人死亡（38%），22在指数发作后30天内。中位随访时间为533天（IQR18-957），有5％（4/73）的随访失败。整个队列中癫痫发作复发率为19%。在癫痫发作后至少30天存活的儿童中，27%有反复发作。从初次发作到反复发作的中位时间为161天（IQR86-269）。中枢神经系统机会性感染（CNSOI），由于指示性癫痫发作的原因是对复发性癫痫发作具有保护性,而较高的功能状态是癫痫发作复发的危险因素.
结论：在出现新发作癫痫的CLWH中，在急性疾病期之后,死亡风险仍然升高.反复发作是常见的，即使在调整死亡结果后，功能水平较高的儿童也更有可能发作。为了照顾这些儿童，需要适合与抗逆转录病毒疗法共同使用的新型抗癫痫药物。CNSOI可能代表索引癫痫发作的潜在可逆挑衅，而无CNSOI的高功能CLWH中的癫痫发作可能是先前脑损伤或与HIV无关的癫痫发作易感性的结果，因此代表了癫痫发作的持续易感性。
结论：这项研究追踪了经历了新发作的癫痫发作的CLWH，以了解有多少人继续发作更多的癫痫发作，并确定与发作更多相关的任何患者特征。研究发现，除了新发作的癫痫发作的急性临床表现外，死亡率仍然很高。中枢神经系统OI导致新发作癫痫发作的儿童有较低的后期癫痫发作风险，可能是因为癫痫发作的诱因可以治疗。相比之下,无CNSOI的高功能儿童未来癫痫发作的风险较高.
