INTRODUCTION Children with either febrile seizure or acute encephalopathy exhibit seizures and/or impaired consciousness accompanied by fever of unknown etiology (SICF). Among children with SICF, we previously reported those who have refractory status epilepticus or prolonged neurological abnormalities with normal AST levels are at a high risk for the development of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), considered to be caused by excitotoxicity. Non-convulsive seizures (NCS) are common in critically ill children and cause excitotoxic neuronal injury. The aim of this study was to elucidate the prevalence of NCS in the acute phase of children at a high risk for developing AESD and the relationship between NCS in the acute phase and neurological outcomes. METHODS We studied 137 children with SICF at a high risk for developing AESD and who underwent continuous electroencephalogram monitoring (cEEG) upon admission to a tertiary pediatric care center at Hyogo Prefectural Kobe Children's Hospital between October 2007 and August 2018. Patient characteristics and outcomes were compared between patients with NCS and without NCS. RESULTS Of the 137 children, NCS occurred in 30 children; the first NCS were detected in cEEG at the beginning in 63.3%, during the first hour in 90%, and within 12 h in 96.7%. Neurological sequelae were more common in NCS patients (20.0%) than in non-NCS patients (1.9%; p = 0.001). Five in 30 NCS patients (16.7%) and 3 in 107 non-NCS patients (2.8%) developed AESD (p = 0.013). CONCLUSION The occurrence of NCS is associated with subsequent neurological sequelae, especially the development of AESD.

中文翻译：

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早期非惊厥性癫痫发作与双相癫痫发作和晚期扩散减少的急性脑病的发展有关

引言 患有热性惊厥或急性脑病的儿童表现为癫痫发作和/或意识障碍，并伴有病因不明的发热 (SICF)。在患有 SICF 的儿童中，我们之前报道过那些患有难治性癫痫持续状态或长期神经系统异常且 AST 水平正常的儿童发生双相癫痫发作和迟发性弥散减少 (AESD) 的急性脑病的风险很高，被认为是由兴奋性毒性引起的. 非惊厥性癫痫发作 (NCS) 在危重儿童中很常见，会导致兴奋性毒性神经元损伤。本研究的目的是阐明 AESD 高危儿童急性期 NCS 的患病率，以及急性期 NCS 与神经系统结局之间的关系。方法 我们研究了 137 名患有 AESD 的高风险 SICF 儿童，他们在 2007 年 10 月至 2018 年 8 月期间在兵库县神户儿童医院的三级儿科护理中心入院时接受了连续脑电图监测 (cEEG)。比较了患者特征和结果NCS 患者和非 NCS 患者之间。结果 137名儿童中，30名儿童发生NCS；第一个 NCS 在开始时在 cEEG 中检测到 63.3%，在第一个小时内检测到 90%，在 12 小时内检测到 96.7%。神经系统后遗症在 NCS 患者 (20.0%) 中比在非 NCS 患者 (1.9%; p = 0.001) 中更常见。30 名 NCS 患者中有 5 名 (16.7%) 和 107 名非 NCS 患者中有 3 名 (2.8%) 发生 AESD (p = 0.013)。结论 NCS 的发生与随后的神经系统后遗症有关，