title: Therapeutic indicators of acute encephalopathy in patients with complex febrile seizures.
abstract: BACKGROUND
  The aim of this study was to identify predictors of neurologic damage in children with febrile seizures or altered consciousness within 6 h of seizure onset.
  
  
  METHODS
  The present study included 86 children (age range, 4-159 months old), who fulfilled the diagnostic criteria for complex febrile seizures on admission between October 2002 and November 2008. Using the Pediatric Cerebral Performance Category Scale (PCPC), the children were classified into two groups: poor outcome (PCPC = 2-6) and good outcome (PCPC = 1). Clinical profiles and laboratory findings were compared between the groups.
  
  
  RESULTS
  Of the 86 children, 17 fell into the poor outcome and 69 into the good outcome group. Using univariate analysis, three early risk factors for poor outcome were identified: (i) consciousness disturbance or hemiplegia at 6 h from onset; (ii) refractory status epilepticus; and (iii) elevation of aspartate aminotransferase to >90 IU/L within 6 h of onset. Using these criteria, children in the poor outcome group were identified with a 94% sensitivity and 67% specificity rate (odds ratio, 36.6; 95% confidence interval: 4.87-1560). During the study period, the inpatients who met the criteria for acute encephalopathy also fell into the poor outcome group.
  
  
  CONCLUSIONS
  The development of neurologic damage in children with complex febrile seizures can be predicted within 6 h of onset, using the identified risk factors. The authors propose an assumption of severe febrile seizures (SFS) in children who fulfill these risk factors. Using SFS as an inclusion criterion, an interventional study for acute encephalopathy can be designed.
authors.affiliation: Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan. nagasehiroaki@msn.com
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagase
authors.forename: Taku
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Aoki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Fujita
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Saji
authors.forename: Azusa
authors.initials: A
authors.lastname: Maruyama
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Uetani
mesh_terms: D000293:Adolescent; D001219:Aspartate Aminotransferases / Q000097:blood; D001925:Brain Damage, Chronic / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000175:diagnosis*; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000175:diagnosis*; D007564:Japan; D065768:Lennox Gastaut Syndrome; D008297:Male; D009460:Neurologic Examination; D011379:Prognosis; D012307:Risk Factors; D003294:Seizures, Febrile / Q000175:diagnosis*; D013036:Spasms, Infantile / Q000175:diagnosis*; D013226:Status Epilepticus / Q000175:diagnosis
chemical_list: D001219:Aspartate Aminotransferases