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.

中文翻译：

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癫痫儿科患者群发发作的患病率和预测因素：哈佛-耶鲁儿科群发发作研究

背景

确定丛集性癫痫发作（6 小时内两次或更多癫痫发作）的发生率、急救药物的使用以及与癫痫严重程度不同的儿科患者丛集性癫痫发作相关的不良后果，并确定预测丛集性癫痫发作的风险因素。

方法

前瞻性观察性双中心研究，包括对 1 个月至 18 岁的癫痫患者进行为期 12 个月的电话随访和癫痫发作日记随访。我们根据前一年内的癫痫发作将患者分为三个风险组：高、丛集性癫痫发作（一天内癫痫发作两次或更多）；中期，至少有一次发作，但没有发作两次或更多次的日子；低，无癫痫发作。

结果

297 名患者中有三分之一（32.3%；高风险，72.4%；中等风险，30.4%；低风险，3.1%）在研究期间出现丛集性癫痫发作，其中一半 (46.2%) 患者在基线时有活动性癫痫发作（中高危人群相结合）。急诊室就诊或受伤的可能性并不比孤立性癫痫发作更可能是由于癫痫发作群引起的。15.8% 的高危组患者和 19.2% 的中危组患者使用了急救药物。癫痫持续状态史（调整后的比值比 [aOR]，2.13；置信区间 [CI]，1.09 至 4.16]）、每月癫痫发作频率大于 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）与更大的癫痫发作几率相关。

结论

癫痫发作在小儿癫痫患者中很常见。高癫痫发作频率是集群的最强预测因子。救援药物没有得到充分利用。未来的研究应该评估这些药物的适用性和有效性，以优化小儿癫痫发作的丛集治疗和减少与癫痫发作相关的急诊就诊、伤害和死亡率。