| 作者：Susan Jeffrey | | 出處：WebMD醫學新聞 |
August 13, 2008 — 丹麥研究者的長期登記研究發現，在28年前發生熱痙攣的小孩，並不會增加長期死亡率。
不過，他們發現，在複雜性熱痙攣（那些持續超過15分鐘或者24小時內復發者）之後約2年，死亡風險略為增加；第一作者、Aarhus大學公共衛生研究中心的Mogens Vestergaard醫師指出，此發現有部分可以用這些小孩原本存在的神經異常和後續的癲癇來解釋。
作者寫道，父母親必須知道熱痙攣之後的死亡很罕見，甚至是高風險的小孩。
他們的研究發現發表於8月9日的Lancet期刊。
【常見異常】
作者寫道，熱痙攣常見，影響2%至5%的5歲前小孩，這些小孩有三分之一發作超過一次；他們指出，許多父母親在他們的小孩第一次發生熱痙攣時認為他們會死掉，對於他們以後還會發生痙攣和死亡感到恐懼。
雖然癲癇的小孩因為潛在的神經異常有比較高的死亡率，但對於熱痙攣小孩的死亡則所知有限；之前的研究因太小型且比較短而無法估計死亡率，不過，他們指出，因為熱痙攣相當常見，即使是小風險也有其公衛上的重要意義。
在這個研究中， Vestergaard醫師等人進行一個大型族群基礎的世代研究，對於1977年1月1日至2004年12月31日間在丹麥出生的1,675,643名獨生子，連結公民服務、健康與死因等登記資料；這些小孩從3個月大追蹤到死亡、遷出或者到2005年8月31日為止，估計第一次熱痙攣之後的整體與案例特定死亡率與存活分析。
整個世代之中，這段期間內有8172名小孩死亡，55,215名有熱痙攣發作史的小孩中有232 名死亡；他們發現，第一次熱痙攣之後的第一年的死亡率高出80%，第二年時高出90% ，但之後則與一般族群的死亡率相近。
研究期間整體組群中第一次熱痙攣之後與無痙攣者的死亡風險比較 初次熱痙攣之後的年數
| 校正死亡率風險比
| 95% CI
| 1
| 1.80
| 1.31 – 2.40
| 2
| 1.89
| 1.27 – 2.70
| > 2 – 4
| 1.16
| 0.80 – 1.63
| >5
| 1.15
| 0.96 – 1.36
|
他們指出，熱痙攣之後2年內每100,000名小孩有132名死亡，無熱痙攣史的小孩中，每100,000名小孩有67名死亡。
研究者也進行重疊病例對照研究，獲取8,172名死亡孩童與40,860名控制組的熱痙攣和神經異常資料等醫療紀錄。
他們指出，單純熱痙攣（發作不到15分鐘或者未在24小時內復發）的小孩，死亡率和一般族群相似，但是複雜性痙攣者的死亡率增加。這增加的死亡率有一部分是因為原本存在的神經異常和後續的癲癇。我們紀錄到特別高的痙攣、肺炎、猝死和神經系統畸形之死亡率。
單純熱痙攣和複雜熱痙攣相較於無痙攣者的死亡率 比較
| 校正死亡率比率
| 95% CI
| 單純熱痙攣
| 1.09
| 0.72 – 1.64
| 複雜熱痙攣
| 1.99
| 1.24 – 3.21
|
【後續需要的注意？】
波士頓兒童醫院神經科的Maitreyi Mazumdar醫師在對於本文獻的建議中指出，儘管一般認為兒童熱痙攣有好的預後 ，熱痙攣依舊和嬰幼兒猝死之病理有關，可能是因為感染或環境因素、解剖異常或者對熱的基因敏感性。
他指出，猝死和熱痙攣之間的因果觀念，在2007年Kinney等人的報告中再度被提出，顯示5個猝死小孩發育中的海馬回有異常；其中 3個小孩有個人和/或家族熱痙攣史 (Kinney H 等人 Pediatr Dev Pathol 2007;10:208-223)。
Mazumdar醫師結論表示，Vestergaard 等人的研究好像再度反駁，對於單純熱痙攣的嬰幼兒猝死和熱痙攣之間的因果觀念；和之前的研究相似，最近的就是Kinney等人的研究，新研究認為有一些熱痙攣的小孩— 那些複雜性痙攣以及原本即有神經異常者— 需密切注意和追蹤。
本研究接受丹麥研究局、 Lennart Gram 紀念信託 (丹麥)、P. A. Messerschmidt夫妻基金會(丹麥)、Managing Director Kurt Bonnelycke 與 Grethe Bonnelyckes 女士基金會 (丹麥)等的贊助。作者宣稱沒有利益衝突。Mazumdar醫師也宣稱沒有利益衝突。 | |
No Increase in Long-Term Mortality After Febrile Seizures, but Some Short-Term Risk
By Susan Jeffrey
Medscape Medical News
August 13, 2008 — A large registry study by Danish researchers finds no increase in long-term mortality among children who had febrile seizures up to 28 years earlier.
However, they did find a small increase in mortality risk for about 2 years following complex febrile seizures — that is, those lasting longer than 15 minutes or recurring within 24 hours. This finding was partly explained by preexisting neurological abnormalities and subsequent epilepsy among these children, the researchers, with first author Mogens Vestergaard, MD, from the Institute of Public Health at Aarhus University, Denmark, note.
"Parents should be reassured that death after febrile seizures is rare, even in high-risk children," the authors write.
Their findings are published in the August 9 issue of the Lancet.
Common Disorder
Febrile seizures are common, affecting 2% to 5% of children before 5 years of age, the authors write, with one-third of these having more than 1 episode. "Many parents think their child is dying during the first febrile seizure and fear that they might die during subsequent seizures," they note.
Although children with epilepsy are well-known to have a higher mortality rate than the general population, mainly due to underlying neurological disorders, little is known about mortality in children with febrile seizures. Previous studies, although too small and short to estimate mortality, suggest that any excess would be small. However, they point out that since febrile seizures are so common, "even small excess risks have public-health importance."
In this study, Dr. Vestergaard and colleagues carried out a large population-based cohort study, identifying 1,675,643 singleton children born in Denmark between January 1, 1977 and December 31, 2004 by linking registers for civil service, health, and cause of death. The children were followed from 3 months of age until death, emigration, or August 31, 2005, and overall and case-specific mortality after first febrile seizures were estimated with survival analyses.
Of the overall cohort, 8172 children died over this period, including 232 deaths in 55,215 children who had a history of febrile seizures. They found that the mortality rate ratio was 80% higher during the first years after a first febrile seizure and 90% higher during the second year after the seizure but thereafter was close to that seen for the general population.
Mortality Risk in Entire Study Population in Period After a First Febrile Seizure vs No Seizure | Years After a First Febrile Seizure | Adjusted Mortality Rate Ratio | 95% CI | | 1 | 1.80 | 1.31 – 2.40 | | 2 | 1.89 | 1.27 – 2.70 | | > 2 – 4 | 1.16 | 0.80 – 1.63 | | > 5 | 1.15 | 0.96 – 1.36 |
There were 132 deaths per 100,000 children within 2 years of a febrile seizure compared with 67 deaths per 100,000 among those without a history of febrile seizure, they note.
The researchers also carried out a nested case-control study, retrieving information from medical records on febrile seizure and neurological abnormalities among the 8172 children who died and 40,860 individually matched controls.
Children with simple febrile seizures, those with lasting less than 15 minutes or not recurring within 24 hours, had a mortality rate similar to the general population, but there was an increased rate of death among those with complex seizures, they note. "This excess mortality was at least partly due to preexisting neurological abnormalities and subsequent epilepsy," they note. "We recorded particularly high [mortality rate ratios] for seizures, pneumonia, sudden unexpected death, and malformation of the nervous system."
Mortality for Simple and Complex Febrile Seizures vs No Seizures | Comparison | Adjusted Mortality Rate Ratio | 95% CI | | Simple febrile seizures | 1.09 | 0.72 – 1.64 | | Complex febrile seizures | 1.99 | 1.24 – 3.21 |
Subset Requiring Attention?
In a Comment accompanying the paper, Maitreyi Mazumdar, MD, from the department of neurology at Children's Hospital, in Boston, Massachusetts, points out that despite the general acceptance that children with febrile seizures have a good prognosis, "the hypothesis persists that febrile seizures are linked etiologically to sudden death in infants and children through a common infectious or environmental agent, anatomical abnormality, or genetic susceptibility to fever."
The idea of shared cause between sudden death and febrile seizures was raised again in a paper published in 2007 by Kinney and colleagues, he notes, showing developmental hippocampal changes in 5 toddlers who died suddenly; 3 of the children had either a personal and/or family history of febrile seizures (Kinney H et al. Pediatr Dev Pathol 2007;10:208-223).
"Vestergaard and colleagues' study again seems to refute, for infants and children who have simple febrile seizures, the idea of shared cause between febrile seizures and sudden death," Dr. Mazumdar concludes. "Similar to previous studies, most recently that of Kinney and colleagues, the new study suggests there is a subset of children with febrile seizures — notably those with complex features and underlying neurological abnormalities — that might warrant closer attention and follow-up."
The study was funded by the Danish Research Agency, Lennart Gram Memorial Trust (Denmark), P. A. Messerschmidt and Wife's Foundation (Denmark), Managing Director Kurt Bonnelycke and Mrs. Grethe Bonnelyckes Foundation (Denmark). The authors declare no conflict of interest. Dr. Mazumdar also declares no conflict of interest.
Lancet. 2008;372:457-463 Abstract, 429-430. Abstract
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[ 本帖最後由 goodcat1111 於 2008-8-23 00:04 編輯 ] |
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