热性痉挛

title: 症状及征象.
content: 在全身性发作时,患者会全身僵硬、手脚抽搐。儿童会失去意识,但双眼会睁开且翻白眼,呼吸可能会不规则。可能大小便失禁、呕吐、口吐白沫,或分泌物增加。症状通常不会维持超过五分钟。患者温度常超过。
title: 发症.
content: 发生的年纪通常介于六个月到五岁之间,但一般不超过六岁,发生率为3到4%。  男、女童的病发率比例,在不同的文献间的说法差异颇大:
title: 起因.
content: 热性痉挛的直接致病原因未明,但按其病征可分为单纯性热性痉挛及复杂性热性痉挛。  单纯性热性痉挛的直接成因多数源于上呼吸道感染、胃肠炎、肺炎、中耳炎等或预防注射后引起的发烧导致,而由于幼童的脑部未完全成熟,对痉挛的抑制力较弱而引致。这种对痉挛较弱的抑制力,已被发现可遗传,相关的遗传因子如下: 而复杂性热性痉挛的成因可以归疚于癫痫、脑畸形、神经皮肤综合症、神经代谢性疾病等各种问题。
title: 诊断、治疗与预防.
content: 其诊断需先确定患者脑部没有受到感染、没有代谢性疾病、并且没有痉挛的病史(发烧时产生的热性痉挛除外)。热性痉挛主要可分为两种类型,单纯的热性痉挛与复杂的热性痉挛。单纯的热性痉挛,是在24小时内至少发作1次僵直阵挛发作(脑组织大规模不规则放电,身体僵硬且不停抽动 ),且持续时间未超过15分钟。诊断热性痉挛不需用到血液检测、大脑影像或脑电波图等技术;但建议确诊患者发烧的原因。此外,对于看起来健康无碍的幼儿患者,不建议采用腰椎穿刺检查。 不建议使用抗癫痫药物或退烧药来预防单纯的热性痉挛发生。少数热性痉挛会持续超过五分钟,此时可使用苯二氮平类药物,如劳拉西泮或咪达唑仑。
title: 预后.
content: 热性痉挛儿童预后通常相当良好,且在学业表现与死亡率上,亦与其他儿童无异。初步研究显示,热性痉挛儿童罹病后,得到癫痫症的几率略增,约为2%。五岁以前的儿童,约有2%至10%得过热性痉挛,且男孩的比例高于女孩。首次得到热性痉挛的病患,有15-70%的机会再次复发。

Summary: 热性痉挛(英语:febrile convulsion),又称作又称作发烧性抽搐、热性抽搐、热性惊厥、热性全身痉挛,是一种癫痫性发作,伴有体温升高的症状但是并无任何潜在的健康问题。常见于六个月至五岁的儿童。其大多数发作时长不超过五分钟,儿童发病后也会在六十分钟之内恢复正常。

Febrile seizure: A febrile seizure, also known as a fever fit or febrile convulsion, is a seizure associated with a high body temperature but without any serious underlying health issue. They most commonly occur in children between the ages of 6 months and 5 years. Most seizures are less than five minutes in duration, and the child is completely back to normal within an hour of the event. There are two types: simple febrile seizures and complex febrile seizures. Simple febrile seizures involve an otherwise healthy child who has at most one tonic-clonic seizure lasting less than 15 minutes in a 24-hour period. Complex febrile seizures have focal symptoms, last longer than 15 minutes, or occur more than once within 24 hours. About 80% are classified as simple febrile seizures. Febrile seizures are triggered by fever, typically due to a viral infection. They may run in families. The underlying mechanism is not fully known, but it is thought to involve genetics, environmental factors, brain immaturity, and inflammatory mediators. The diagnosis involves verifying that there is not an infection of the brain, there are no metabolic problems, and there have not been prior seizures that have occurred without a fever. Blood testing, imaging of the brain, or an electroencephalogram (EEG) is typically not needed. Examination to determine the source of the fever is recommended. In otherwise healthy-looking children a lumbar puncture is not necessarily required. Neither anti-seizure medication nor anti-fever medication are recommended in an effort to prevent further simple febrile seizures. In the few cases that last greater than 5 minutes, a benzodiazepine such as lorazepam or midazolam may be used. Efforts to rapidly cool during a seizure is not recommended. Febrile seizures affect 2-10% of children. They are more common in boys than girls. After a single febrile seizure there is an approximately 35% chance of having another one during childhood. Outcomes are generally excellent with similar academic achievements to other children and no change in the risk of death for those with simple seizures. There is tentative evidence that affected children have a slightly increased risk of epilepsy at 2% compared to the general population.