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- Martinos, M. M., et al.
(författare)
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Long-term behavioural outcomes after paediatric convulsive status epilepticus: a population-based cohort study
- 2018
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Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 60:4, s. 409-416
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe behavioural and psychiatric outcomes of children within 10 years of convulsive status epilepticus (CSE). Method: Children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study were followed-up between July 2009 and February 2013. They were grouped into epilepsy- and non-epilepsy-related CSE, and compared with population norms and healthy controls using the Strengths and Difficulties Questionnaire; the Autism Spectrum Screening Questionnaire; and the Swanson, Nolan, and Pelham questionnaire. Children who scored above recommended clinical cut-offs on any scale were invited for a neuropsychiatric assessment. Regression models were fitted to identify clinically relevant covariates associated with behavioural outcomes. Results: At a mean follow-up of 8.1 years post-CSE, 28% of enrolled children were found to have a psychiatric disorder. Children with epilepsy-related CSE scored higher than norms on all scales and children with non-epilepsy-related CSE scored higher than norms on the Strengths and Difficulties Questionnaire and the Autism Spectrum Screening Questionnaire. Presence of seizures at baseline and recurrence of CSE was associated with worse outcomes in the group with epilepsy. Intellectual abilities were associated with behavioural outcomes in all participants. Interpretation: A large proportion of children manifest behavioural issues 8 years after CSE. The present data highlight the need for behavioural screening in children with neurodevelopmental impairments post-CSE. What this paper adds: Eight years post convulsive status epilepticus (CSE), 37% of parents report behavioural issues. Of enrolled children, 28% were found to have a Diagnostic and Statistical Manual mental disorder. Intellectual abilities are strongly associated with behavioural outcomes in children post-CSE. © 2017 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.
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- Pujar, S. S., et al.
(författare)
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Long-term prognosis after childhood convulsive status epilepticus: a prospective cohort study
- 2018
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Ingår i: Lancet Child & Adolescent Health. - : Elsevier BV. - 2352-4642. ; 2:2, s. 103-111
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Tidskriftsartikel (refereegranskat)abstract
- Background The prognosis of convulsive status epilepticus (CSE), a common childhood medical neurological emergency, is not well characterised. We aimed to investigate the long-term outcomes in a cohort of participants who previously had CSE. Methods In this prospective study, we followed up a population-based childhood CSE cohort from north London, UK (the north London convulsive status epilepticus surveillance study cohort; NLSTEPSS). We collected data from structured clinical neurological assessment, neurocognitive assessment (Wechsler Abbreviated Scale of Intelligence), brain MRI, medical records, and structured interviews with participants and their parents to determine neurological outcomes, with adverse outcome defined as presence of one or more of epilepsy (active or in remission), motor disability, intellectual disability, or statement of special educational needs. We applied multiple imputation to address missing data and performed binary logistic regression analyses on complete-case and imputed datasets to investigate sociodemographic and CSE factors associated with adverse outcomes. Findings Of 203 survivors (90% of inception cohort), 134 (66%) were assessed at a median follow-up of 8.9 years (IQR 8.2-9.5). The cumulative incidence of epilepsy was 24.7% (95% CI 16.2-35.6), with most (89%) emerging within 18 months after CSE. The cumulative incidence of epilepsy was lower in patients with prolonged febrile seizures (14.3%, 6.3-29.4) and survivors of acute symptomatic CSE (13.3%, 3.7-37.9) than in those of remote symptomatic CSE (45.5%, 21.3-72.0) and unclassified CSE (50.0%, 25.4-74.6). One participant (2.9%, 0.5-14.5) in the prolonged febrile seizures group developed temporal lobe epilepsy with mesial temporal sclerosis. The absence of fever at CSE was the only predictor of incident epilepsy (odds ratio [OR] 7.5, 95% CI 2.25-25.1). Motor and intellectual disability was seen predominantly in participants who had idiopathic and cryptogenic CSE (seven [36.8%, 95% CI 19.1-59.0] and 16 [84.2%, 62.4-94.5] of 19, respectively) and remote symptomatic CSE (33 [62.3%, 48.8-74.1] and 40 [75.5%, 62.4-85.1] of 53), and most of these participants had pre-existing disabilities. Pre-existing epilepsy was the only predictor of intellectual disability (OR 8.0, 95% CI 1.1-59.6). 51.5% (95% CI 43.1-59.8) of those followed up had a statement of special educational needs. Interpretation Childhood CSE is associated with substantial long-term neurological morbidity, but primarily in those who have epilepsy, neurological abnormalities, or both before the episode of CSE. Survivors without neurological abnormalities before CSE have favourable outcomes. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
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