热性惊厥与猝死风险：病例-对照分析

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-06-11 DOI:10.1016/j.pediatrneurol.2025.06.004

Laura Gould MSc , Steven Friedman MS , Thomas Wisniewski MD , Orrin Devinsky MD

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引用次数: 0

摘要

背景：在6个月至5岁的美国儿童中，有3%-4%的儿童发生发热性癫痫发作，并且被认为是良性的。然而，儿童期不明原因的猝死与热性惊厥增加10倍有关。我们评估了热性惊厥和猝死儿童的特征，以确定导致猝死风险增加的因素。方法通过一项10分钟的匿名在线调查，对2021年12月至2023年6月期间发生热性惊厥并随后猝死的儿童与活着的对照组进行病例对照分析。我们招募了孩子的父母，活着的或死去的，他们的孩子从6个月到6岁经历过热性癫痫发作。如果儿童有发热性发作或父母没有目睹发热性发作，受试者被排除在外。分析人口学特征、睡眠异常和热性惊厥特征。结果共收到调查问卷381份；53例（14%）发热性惊厥并发猝死，328例（86%）存活对照。病例报告发热性癫痫发作早2个月（P = 0.013），并报告有发育问题（优势比[OR] = 2.32, 95%可信区间[CI] [1.14, 4.71], P = 0.03），夜间醒来次数减少（OR = 0.34, 95% CI [0.18, 0.65], P = 0.001），不安稳睡眠减少（OR = 0.37, 95% CI [0.16, 0.85], P = 0.02）。患者流口水的可能性也更小（OR = 0.442, 95% CI [0.218, 0.900], P = 0.032）或无反应超过1分钟（OR = 0.45, 95% CI [0.238, 0.854], P = 0.021）。结论：我们报告了与年龄、发育、睡眠和观察到的体征特征有关的热性惊厥和猝死的新关联。匿名调查方法不能排除确定偏差和对结果的任何相关潜在影响。我们的研究结果表明，觉醒机制受损可能会增加热性惊厥患者的死亡风险。

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Febrile Seizures and Sudden Death Risk: A Case-Control Analysis

Background

Febrile seizures occur in 3%-4% of US children aged six months to five years and are considered benign. However, sudden unexplained death in childhood is associated with 10 times increase in febrile seizures. We assessed the characteristics of children with febrile seizure and sudden death to identify factors that confer increased sudden death risk.

Methods

We conducted a case-control analysis of children with febrile seizure and subsequent sudden death versus living controls from December 2021 to June 2023 through an ∼10-minute anonymous online survey. We enrolled parents of children, living or deceased, whose child had experienced a febrile seizure from age six months to six years. Subjects were excluded if the child had an afebrile seizure or parents had not witnessed a febrile seizure. Demographic characteristics, parasomnias, and febrile seizure features were analyzed.

Results

A total of 381 completed surveys were received; 53 (14%) cases of febrile seizure with sudden death and 328 (86%) living controls. Cases reported febrile seizure onset >2 months earlier (P = 0.013) and reported developmental concerns (odds ratio [OR] = 2.32, 95% confidence interval [CI] [1.14, 4.71], P = 0.03), less frequent night awakenings (OR = 0.34, 95% CI [0.18, 0.65], P = 0.001), and less restless sleep (OR = 0.37, 95% CI [0.16, 0.85], P = 0.02). Cases were also less likely to drool (OR = 0.442, 95% CI [0.218, 0.900], P = 0.032) or be unresponsive for more than one minute (OR = 0.45, 95% CI [0.238, 0.854], P = 0.021).

Conclusions

We report novel associations of febrile seizure and sudden death related to age, development, sleep, and observed ictal features. Anonymous survey methodology cannot exclude ascertainment bias and any related potential effect on results. Our findings suggest that impaired arousal mechanisms may increase risk of death in subjects with febrile seizure.

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.