小児けいれん重延状態の臨床的研究

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タイトル別名
  • A Clinical Study of Status Convulsivus in Childhood

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The purpose of the present study was to investigate the following four points in connection with status convulsivus in childhood; 1) the prevalence of patients with status epilepticus among epileptic children; 2) clinical pictures of status convulsivus in the acute stage; 3) follow-up observation of children with a history of status epilepticus, and 4) the characteristics of patients with recurring status convulsivus as compared with those who experienced a single episode of status only.<BR>The records of 348 epileptic patients under 15 years of age who visited our outpatient clinic for the first time during the period between October 1977 and September 1978, the records of 67 children hospitalized for an episode of status convulsivus between January 1975 and October 1978, and the records of 32 epileptic outpatients hospitalized before 1974 and followed up as outpatients were studied and applied to each of the four above-mentioned points.<BR>The frequency of status epilepticus was 8% among epileptic children. There was no difference in the frequency of incidence between males and females. Patients with mental retardation, however, were found to have status epilepticus two to three times more frequently than those with normal intellects.<BR>The major seizure types of status epilepticus in childhood were generalized tonic clonic convulsions and unilateral clonic convulsions. In 25% of the cases, status epilepticus was the first ictal manifestation. The major cause of status convulsivus was epilepsy, followed by encephalitis and encephalopathy in order of frequency. Cases in which the condition was caused by brain tumor were rare.<BR>Diazepam is widely recognized as the drug of first choice for status convulsivus. In our experiences, the effective dose of diazepam was within the range of 0.3-0.5mg/kg. If the results are not sufficient at this dosage, it should be increased to 1mg/kg while watching the general condition of the patients. If there is any difficulty in controlling the condition in this manner, it may be worthwhile to investigate the cause of the status convulsivus, the seizure type and/or the basic disease of the patient.<BR>Status convulsivus could be classified into three types according to the characteristics of the condition: Type A (continuous convulsion); Type B (frequent and repetitive convulsions), and Type C (continuous convulsion and frequent and repetitive convulsions).<BR>Most of the patients fell into Type A. The age distribution did not differ for Types A and B. As a cause, epilepsy was dominant in each group. In the C Type, however, causes other than epilepsy were noted more frequently than in the A and B Types. There was no difference in the frequency of idiopathic and symptomatic epilepsy between the A and B Types. As a seizure type, unilateral clonic convulsion was dominant in the A Type and generalized clonic convuision and generalized tonic convulsion in the B Type.<BR>The duration of the convulsion was within two hours for most of the A Type patients. This was longer, however, for about half of the patients of the B and C Types. The anticonvulsive effects of diazepam were better for the A Type and somewhat less noticeable among the patients with the B and C Types.<BR>Factors affecting the prognosis of status convulsivus were its cause, duration, onset age, effectiveness of therapy during the acute stage and the type of the status.<BR>The frequency of cases who suffered disability after status epilepticus was 56%(transient disability 43% and permanent disability 13%).<BR>Pathologic backgrounds for repeating status were usually either hemispheric brain damage or diffuse corticocentrencephalic damage.

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  • 脳と発達

    脳と発達 12 (4), 308-328, 1980

    THE JAPANESE SOCIETY OF CHILD NEUROLOGY

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