小儿动静脉畸形破裂后的电图癫痫发作和预测因素

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2024-09-28 DOI:10.1016/j.jpeds.2024.114325

Julia S. Keenan BS , Dana B. Harrar MD, PhD , Claire Har MPH, BS , Caroline Conley DNP, CPNP-AC/PC , Katelyn Staso MS, CPNP-AC , Arnold J. Sansevere MD

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引用次数: 0

摘要

研究目的评估癫痫的临床和脑电图（EEG）预测因素，并描述因动静脉畸形（AVM）破裂导致的自发性脑内出血（ICH）患者中电图癫痫发作（ES）和癫痫发展的百分比：研究设计：对11年来因动、静脉畸形（AVM）破裂导致自发性脑内出血（ICH）而入住儿科重症监护室的患者进行回顾性研究。通过查看电子病历收集临床变量。癫痫发作被描述为急性症状（动静脉畸形破裂后 7 天）、亚急性（动静脉畸形破裂后 7-30 天）和远期（动静脉畸形破裂后 30 天以上）。结果指标包括死亡率和出院后癫痫的发生率。研究采用了描述性统计方法：43名患者符合纳入标准，中位年龄为12.2岁（IQR为7.3-14.8），49%（21/43）为女性。16%的患者（7/43）在接受脑电图检查前出现临床癫痫发作。62%的患者（27/43）接受了脑电图检查；其中一名患者有无临床症状的电图癫痫状态。16%的患者（7/43）被确诊为癫痫，中位确诊时间为 AVM 破裂后 1.34 年（IQR 0.55-2.07）。一年无癫痫生存率为 84%（95% CI 70%-98%），两年无癫痫生存率为 79%（95% CI 63%-95%）：脑电图确诊的癫痫发作在因动静脉畸形破裂继发 ICH 的患者中并不常见；但一旦确诊，癫痫发作的负担似乎很高。在动静脉畸形破裂 30 天后出现癫痫发作的患者更有可能发展为癫痫。

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Electrographic Seizures and Predictors of Epilepsy after Pediatric Arteriovenous Malformation Rupture

Objectives

To assess clinical and electroencephalogram (EEG) predictors of epilepsy and to describe the percentage of electrographic seizures and development of epilepsy among patients with spontaneous intracerebral hemorrhage (ICH) due to arteriovenous malformation (AVM) rupture.

Study design

Retrospective review of patients admitted to the pediatric intensive care unit with ICH secondary to AVM rupture over 11 years. Clinical variables were collected by review of the electronic medical record. Seizures were described as acute symptomatic (7 days after AVM rupture), subacute (7-30 days after AVM rupture) and remote (greater than 30 days after AVM rupture). Outcome metrics included mortality, and the development of epilepsy post discharge. Descriptive statistics were used.

Results

Forty-three patients met inclusion criteria with a median age of 12.2 years (IQR 7.3-14.8) and 49% (21/43) were female. Sixteen percent (7/43) presented with a clinical seizure prior to EEG placement. EEG was performed in 62% (27/43) of patients; one had electrographic status epilepticus without clinical signs. Sixteen percent (7/43) of patients were diagnosed with epilepsy, with a median time to diagnosis of 1.34 years (IQR 0.55-2.07) after AVM rupture. One-year epilepsy-free survival was 84% (95% CI 70%-98%) and 2-year epilepsy-free survival was 79% (95% CI 63%-95%) Remote seizures were associated with epilepsy (P < .001), but acute symptomatic seizures were not (P = .16).

Conclusions

EEG-confirmed seizures are uncommon in patients with ICH secondary to AVM rupture; however, when identified, the seizure burden appears to be high. Patients with seizures 30 days after AVM rupture are more likely to develop epilepsy.

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来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.