Consequences of Prolonged Febrile Seizures in Childhood

儿童时期长期热性惊厥的后果

• 批准号: 6579966
• 负责人: Shlomo Shinnar
• 金额: $ 201.55万
• 依托单位: MONTEFIORE MEDICAL CENTER (BRONX, NY)
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-02-01 至 2008-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6579966
• 关键词: clinical research; cognition disorders; convulsions; electroencephalography; epilepsy; febrile seizure; generalized seizures; hippocampus; human subject; infant human (0-1 year); longitudinal human study; magnetic resonance imaging; middle childhood (6-11); nervous system disorder epidemiology; neuropsychological tests; preschool child (1-5); sclerosis

DESCRIPTION (provided by the applicant): Temporal Lobe Epilepsy (TLE) is often associated with Mesial Temporal Sclerosis (MTS). The relationship between Febrile Seizures (FSs) and MTS remains controversial. Retrospective data suggest that prolonged FSs cause MTS, but epidemiological studies have not found this association. Recent data from MRIs performed immediately after FSs provide preliminary evidence that very prolonged FSs (i.e. febrile Status Epilepticus (SE)) sometimes produce acute hippocampal injury that evolves into MTS. Identification of children at high risk to develop MTS is necessary prior to designing interventions aimed at prevention. This study will examine the consequences of febrile SE, and clarify the relationship between febrile SE, MTS, and subsequent epilepsy and cognitive impairment. Short-term consequences will be examined using a cohort of 200 children with febrile SE, who will be recruited at 5 centers. All children will have MRIs within 72 hours of their SE and at one year, as well as viral studies, psychological testing, EEGs and clinical follow-up. Intermediate term outcomes (5-9 years) will be ascertained using a cohort of 40 children recruited between 1995 and 200, all of whom had MRIs within 72 hours of the episode of febrile SE. They will have a follow-up MRI, EEG and psychological testing >5 years later. Long-term (10-20 years) outcomes will be examined using an established epidemiologic cohort of 163 children with febrile SE, prospectively identified between 1984 and 1996. These children will receive an MRI, EEG and psychological testing >10 years later. In those who develop epilepsy, we will characterize seizure types and epilepsy syndromes, and correlate them with the presence or absence of MTS. The following hypotheses will be tested: 1) Hippocampal T2 signal and/or volume abnormalities will be seen on 30-40% of acute MRIs. The occurrence and severity of these abnormalities will correlate with total seizure duration and seizure lateralization, the presence of pre-existing brain abnormalities and febrile SE in the context of human herpes virus 6 or 7 infection; 2) The severity of acute MRI hippocampal abnormalities will predict subsequent MTS; 3) Children developing TLE will have MRI evidence of MTS.; 4) Subjects with MTS will have impaired memory, whether or not they have epilepsy.

描述（由申请人提供）：颞叶癫痫 (TLE) 通常与内侧颞叶硬化症 (MTS) 相关。 高热惊厥 (FS) 与 MTS 之间的关系仍存在争议。 回顾性数据表明，长时间的 FS 会导致 MTS，但流行病学研究尚未发现这种关联。 FS 后立即进行的 MRI 的最新数据提供了初步证据，表明非常长时间的 FS（即发热性癫痫持续状态 (SE)）有时会产生急性海马损伤，进而演变成 MTS。 在设计旨在预防的干预措施之前，有必要确定罹患 MTS 的高风险儿童。 本研究将探讨发热性 SE 的后果，并阐明发热性 SE、MTS 以及随后的癫痫和认知障碍之间的关系。 短期后果将通过 200 名患有发热性 SE 的儿童组成的队列进行检查，这些儿童将在 5 个中心招募。 所有儿童将在 SE 发生后 72 小时内和一年后进行 MRI 检查，以及病毒研究、心理测试、脑电图和临床随访。 中期结果（5-9 年）将通过 1995 年至 200 年间招募的 40 名儿童队列来确定，所有这些儿童均在发热性 SE 发作后 72 小时内进行了 MRI 检查。 5 年后，他们将进行后续 MRI、EEG 和心理测试。 将使用 163 名发热性 SE 儿童的既定流行病学队列来检查长期（10-20 年）结果，这些儿童在 1984 年至 1996 年间前瞻性地确定。这些儿童将在 10 年后接受 MRI、EEG 和心理测试。 对于癫痫患者，我们将描述癫痫发作类型和癫痫综合征的特征，并将它们与 MTS 的存在或不存在相关联。 将测试以下假设：1) 30-40% 的急性 MRI 会出现海马 T2 信号和/或体积异常。 这些异常的发生和严重程度将与总癫痫发作持续时间和癫痫偏侧化、先前存在的大脑异常的存在以及人类疱疹病毒 6 或 7 感染情况下的发热性 SE 相关； 2）急性MRI海马异常的严重程度将预测随后的MTS； 3) 患有 TLE 的儿童将有 MTS 的 MRI 证据； 4）患有MTS的受试者无论是否患有癫痫，都会出现记忆障碍。