领域：学术论文 · 自然科学

Results: 
Evaluation of FS 
All the published guidelines agree that no further investigation is routinely necessary for children with a single episode of SFS[8]-[14] (Table 2). The British guidelines suggest measurement of blood glucose concentration if the child is still convulsing or unrousable when seen either with or without fever and to consider neuroimaging before lumbar puncture (LP) if the child is comatose.[10] According to ILAE guidelines, it is recommended to search for the fever’s etiology in the case of CFS. Additionally, neuroimaging is recommended to investigate a possible underlying brain lesion. Blood chemical tests are suggested in relation to specific clinical conditions.[8] The AAP underscores the importance of evaluating the underlying cause of fever but recommends that blood tests should not be performed routinely for the sole purpose of identifying the cause of SFS, since there is no evidence to suggest that routine blood studies are of benefit in the evaluation of the child with SFS and there could be a preponderance of harm over benefit.[12]

Japanese guidelines suggest that blood examination should be considered in cases of poor general condition, prolonged altered consciousness, or signs of dehydration.[9] These guidelines also recommend neuroimaging only before LP, as previously stated in the British guidelines,[10] due to the risk of cerebral herniation. By contrast, the Mexican guidelines recommend neuroimaging in patients with FS who do not regain complete consciousness in hours, with prolonged Todd paralysis, or with other focal neurological alterations.[13]

According to the AOCN guidelines, urine analysis should be considered in children aged <18 months, as most children do not have a focus of infection, and magnetic resonance imaging (MRI) should be considered in children with the first episode of CFS with prolonged or focal features (within 72 hours).[14]

The role of the EEG

In all the existing guidelines, electroencephalography (EEG) is not recommended in case of a first episode of SFS, due to its limited diagnostic value.[8,9,13,14] ILAE guidelines recommend performing an EEG in CFS, owing to the high diagnostic value it may have for some viral encephalitides.[8]

Similarly, according to the Japanese guidelines, EEG may have a role in differentiating between acute encephalopathy and CFS, but few peer-reviewed reports have appeared in literature validating the utility of EEG for such differentiation.[9] Even though the Japanese guidelines conclude that EEG examination is not indicated for children with SFS, the authors highlight the possible correlation between epileptiform discharges on EEG and development of epilepsy, as well as its usefulness in the diagnosis of acute encephalopathy. Moreover, the Mexican guidelines recommended EEG in a focal and/or prolonged convulsion, or in CFS if the neurological examination shows alterations.[13] According to the AOCN, EEG should be considered in children with CFS or in children with focal findings on neuroimaging.[14] In cases of prolonged altered mental status, the EEG is not useful to predict recurrence of FS or future epilepsy. Moreover, it is important to note that if EEG were useful to identify viral encephalitis, that would establish an alternative diagnosis of viral encephalitis, causing both fever and provoked seizure, and potentially invalidate the initial working diagnosis of CFS. The AOCN suggests that EEG is not recommended in developmentally normal children with SFS because it does not predict the recurrence of FS or subsequent epilepsy.[14]

The role of the LP

All the published guidelines recommend performing LP if there are meningeal signs or if a CNS infection is suspected (see Table 2). According to the British guidelines, LP should also be performed after a CFS or if the child is unduly drowsy or irritable or systemically ill.[10] The guidelines also state that LP should probably be performed in children aged less than 18 months and almost certainly in children aged less than 12 months, regardless of meningeal signs.[10] They specify that ideally the decision should be taken by an experienced doctor, who may decide on clinical grounds that LP is unnecessary even in a younger child, but when in doubt the investigation should be performed.[11] Similarly, the AOCN guidelines declare that LP should be considered in children aged <12 months with first episode of FS and in children aged >12 months who have been pretreated with antibiotics.[14]

The age threshold for performing LP outlined in these older recommendations differs from the most recent ones.[8,12,13] In particular, the AAP states that LP is an option for any infant aged between six and 12 months who has not received scheduled immunizations for Haemophilus influenzae type B or Streptococcus pneumoniae or when the immunization status cannot be determined.[12] Additionally, LP may be considered when the child has recently been treated with antibiotics, as suggested by clinical experience and case series. LP may be an option in the child who is pretreated with antibiotics, because antibiotic treatment can mask the signs and symptoms of meningitis.[12]

Similarly, the Mexican guidelines state that LP is indicated in children aged <12 months who have not completed their immunizations or have received previous antibiotic treatment or in children aged less than six months with SFS unless an experienced pediatrician evaluates the patient before two hours.

ILAE guidelines do not give mandatory indications on whether to routinely perform LP in younger patients, but suggest a careful observation of children aged <18 months for at least 24 hours, since at this age clinical signs and symptoms for meningitis may be minimal and LP must be performed in the presence of meningeal signs.[8,10,12] Moreover, they suggest considering LP also in patients under antibiotic treatment during the days before FS.[8]

Pharmacologic prophylaxis and home treatment of FS

Almost all published guidelines state that neither intermittent nor continuous seizure prophylaxis is recommended in SFS (see Table 2), except for few cases mentioned below.[8,11,13,14] The prevailing recommendation against prophylactic treatment stems from the consideration that such medications carry significant side effects and do not prevent the development of epilepsy. According to ILAE, intermittent prophylaxis may be considered in cases with high risk of recurrence, defined as at least three episodes in six months or at least four episodes in one year, or CFS due to prolonged duration lasting more than 15 minutes or requiring pharmacologic therapy to be stopped.[8,16–18] Intermittent prophylaxis of FS consists in administering rectal (first choice) or oral diazepam at the onset of fever, to be repeated if fever persists after eight hours.[8]

In case of failure of intermittent prophylaxis and when parents are unable to promptly recognize the onset of fever, ILAE guidelines state that continuous ASMs with phenobarbital or valproic acid may be used.[8] as previously stated in the Japanese guidelines published in 1996.[19] The AAP states that neither continuous nor intermittent seizure prophylaxis is recommended for children with one or more SFS, based on randomized controlled trials and diagnostic studies with minor limitations.[11,16,17] Nonetheless, according to the AAP guidelines, intermittent oral diazepam at the onset of febrile illness may be considered and effective in preventing recurrence in cases of severe parental anxiety associated with FS.[11] Japanese guidelines suggest considering prophylaxis with ASM also in case of severe parental anxiety.[9]

Japanese guidelines recommend the prophylactic use of diazepam during febrile illness in children at high risk of recurrence of FS.[9] As suggested in the study conducted by Berg et al., and Pavlidou et al., who both studied children with a first episode of FS,[18,20] risk factors of recurrence include young age at onset, positive family history of FS, abnormal perinatal history, low degree of fever while in the emergency department (ED), brief duration between the onset of fever and the initial seizure, recurrence within the same illness, partial onset, or focal features of FS. According to several studies, the use of prophylactic diazepam for the prevention of FS is indicated in children with a history of a prolonged FS (lasting longer than 15 minutes) and in children with repeated FS and two of the following risk factors: focal or repeated seizures within 24 hours, pre-existing neurological abnormality or developmental delay, family history of FS or epilepsy, age less than 12 months, seizure within one hour after the onset of fever, or seizure occurring with body temperature less than 38°C[9][21–24].

In the British guidelines long-term prophylaxis with ASM (valproic acid, phenobarbitone) is not recommended, according to previous studies,[25] except in case of frequent recurrences.[10] According to the Mexican guidelines, treatment with ASM should be considered in patients with long or repetitive FS despite the prophylactic use of diazepam.[13]

The AOCN guidelines recommend considering intermittent prophylaxis among children with frequent recurrent SFS with parental anxiety, residence far from medical facilities, and those with CFS who have not been started on continuous prophylaxis. On the other hand, continuous prophylaxis should be considered among children with febrile status epilepticus, in children with neurodevelopmental delay, and in frequent CFS.[14]

Home treatment for FS is recommended in four guidelines (UK, ILAE, Mexican, AOCN). An ASM (rectal diazepam or intranasal midazolam) should be administered if FS last more than three minutes (ILAE), five minutes (UK, Mexican), or three to five minutes (AOCN). In particular, ILAE recommends administering rectal diazepam only if the seizure lasts longer than three minutes.[8]

In the British guidelines there is no agreement on the timing of administration of rectal diazepam: some members of the working group—although neither percentages of members nor studies on which the statements are based on are specified—suggest administering it as soon as possible after the onset of a convulsion, whereas others advised waiting for five minutes, by which time most convulsions will have stopped and ASMs will not be necessary.[10] Indeed, the use of therapies to prevent subsequent epilepsy is not recommended.[8] The British, Mexican, and AOCN guidelines underline the importance of parental education and suggest providing exhaustive information to parents both verbally and possibly written.[10,13,14] Health education should include a description of features of FS and instructions on how to manage possible recurrences.[8]

翻译考点：
考点1：“Febrile Seizures (FS)”推荐译为“热性惊厥”，【关键内容，为全文主题】
考点2：“Simple Febrile Seizures (SFS)”推荐译为“单纯性热性惊厥”，
考点3：“Complex Febrile Seizures (CFS)”推荐译为“复杂性热性惊厥”，
考点4：“Lumbar Puncture (LP)”推荐译为“腰椎穿刺”，
考点5：“Neuroimaging”推荐译为“神经影像学检查”，
考点6：“Electroencephalography (EEG)”推荐译为“脑电图”，
考点7：“Central Nervous System (CNS) Infection”推荐译为“中枢神经系统感染”，
考点8：“Cerebral Herniation”推荐译为“脑疝”，
考点9：“Todd Paralysis”推荐译为“托德瘫痪”，
考点10：“Focal Neurological Alterations”推荐译为“局灶性神经功能异常”，【易错点 "alterations"在神经科特指"功能异常"，非泛指"系统异常"】
考点11：“Urine Analysis”推荐译为“尿液分析”，
考点12：“Magnetic Resonance Imaging (MRI)”推荐译为“磁共振成像”，
考点13：“Viral Encephalitides”推荐译为“病毒性脑炎”，
考点14：“Acute Encephalopathy”推荐译为“急性脑病”，
考点15：“Epileptiform Discharges”推荐译为“癫痫样放电”，
考点16：“Meningeal Signs”推荐译为“脑膜刺激征”，
考点17：“Immunization Status”推荐译为“免疫接种状态”，
考点18：“Haemophilus influenzae type B (HIB)”推荐译为“b型流感嗜血杆菌”，
考点19：“Streptococcus pneumoniae”推荐译为“肺炎链球菌”，
考点20：“Continuous Prophylaxis”推荐译为“持续性预防”，【易错点 "Continuous"在文中应翻译为持续性而不是连续或长期】
考点21：“Antiseizure Medications (ASMs)”推荐译为“抗癫痫药物”，
考点22：“within the same illness”推荐译为“同一病程内”，【易错点 结合上下文illness应翻译为"病程"，而不是"疾病"。结合上下文illness应翻译为"病程"，而不是"疾病"】
考点23：“and possibly written”推荐译为“书面材料”，【易错点 结合上下文written应翻译为书面材料，比如出院小结、告知书等材料，而不是信息、书信等】
考点24：“residence far from medical facilities”推荐译为“居住地远离医疗机构”，【"facilities"在文中语境应译"机构"，比如医院等，设施指CT等设备，而不是"设施"】
考点25：“abnormal perinatal history”推荐译为“围产期异常史”，【易错点 医学专业表达习惯为"异常史"，是指病史中的既往史部分，若翻译为"病史异常"则不专业且容易有歧义】
考点26：“AOCN (Association of Child Neurology India)”推荐译为“印度儿童神经病学协会”。