背景:确定癫痫发作簇的患病率(六小时内两次或更多次癫痫发作),使用救援药物,以及与一系列癫痫严重程度的儿科患者的癫痫发作集群相关的不良结果,并确定预测癫痫发作集群的风险因素。
方法:前瞻性观察性两中心研究,包括1个月至18岁癫痫患者的电话和癫痫发作日记随访12个月。我们根据前一年的癫痫发作将患者分为三个风险组:高,癫痫发作集群(一天内两次或更多次癫痫发作);中间,至少一次癫痫发作,但没有两次或更多次癫痫发作的天数;低,没有癫痫发作。
结果:三分之一(32.3%;高风险,72.4%;中等风险,30.4%;低风险,在研究期间,297名患者中有3.1%)出现癫痫发作集群,包括一半(46.2%)基线时出现活动性癫痫发作的患者(中、高危人群合并).急诊室就诊或受伤的可能性并不比癫痫发作更多。高危组15.8%的患者使用了抢救药物,中危组19.2%的患者使用了抢救药物。癫痫持续状态病史(调整后比值比[aOR],2.13;置信区间[CI],1.09to4.16]),每月发作频率大于4次(AOR,4.27;CI,1.92至9.50),和高危人群状态(AOR,6.42;CI,2.97至13.87)与更大的癫痫发作簇几率相关。
结论:癫痫发作在小儿癫痫患者中很常见。高发作频率是聚类的最强预测因子。救援药物未得到充分利用。未来的研究应评估这些药物的适用性和有效性,以优化小儿癫痫发作集束治疗和减少癫痫相关的急诊就诊。受伤,和死亡率。
BACKGROUND: Determine the prevalence of seizure clusters (two or more seizures in six hours), use of rescue medications, and adverse outcomes associated with seizure clusters in pediatric patients with a range of epilepsy severities, and identify risk factors predictive of seizure clusters.
METHODS: Prospective observational two-center
study, including phone call and seizure diary follow-up for 12 months in patients with epilepsy aged one month to 18 years. We classified patients into three risk groups based on seizures within the prior year: high, seizure cluster (two or more seizures within one day); intermediate, at least one seizure but no days with two or more seizures; low, no seizures.
RESULTS: One-third (32.3%; high risk, 72.4%; intermediate risk, 30.4%; low risk, 3.1%) of 297 patients had a seizure cluster during the
study, including half (46.2%) of the patients with active seizures at baseline (intermediate- and high-risk groups combined). Emergency room visits or injuries were no more likely due to a seizure cluster than an isolated seizure. Rescue medications were utilized in 15.8% of patients in the high-risk group and 19.2% in the intermediate-risk group. History of status epilepticus (adjusted odds ratio [aOR], 2.13; confidence interval [CI], 1.09 to 4.16]), seizure frequency greater than four per month (aOR, 4.27; CI, 1.92 to 9.50), and high-risk group status (aOR, 6.42; CI, 2.97 to 13.87) were associated with greater odds of seizure cluster.
CONCLUSIONS: Seizure clusters are common in pediatric patients with epilepsy. High seizure frequency was the strongest predictor of clusters. Rescue medications were underutilized. Future studies should evaluate the applicability and effectiveness of these medications for optimization of pediatric seizure cluster treatment and reduction of seizure-related emergency department visits, injuries, and mortality.