| Objective: To analyze the changes of hippocampal volume and hippocampus injury in children with recurrent febrile convulsion during the course of disease based on MRI,and the influencing factors of hippocampal injury and transformation into epilepsy.Methods: 34 children with recurrent febrile seizures were selected from the Department of pediatric neurology,Shengjing Hospital.They were followed up in pediatric neurology from January 1,2013 to September 30,2019.During this period,34 patients with 2 times of head and hippocampus MRI scan were completed.By retrospective analysis,the volume of bilateral hippocampus and the damage of hippocampal structure were measured respectively.Meanwhile,the general medical records of the children were collected,including the age of onset,gender,age,duration,family history,source,status epilepticus,history of complex febrile convulsion,and the average number of convulsions per year,whether to change into epilepsy,and gene test result.Spearman correlation analysis,independent sample t test,Mann Whitney U and Kruskal-Wallis H test were used to determine the change of hippocampal volume,and Fisher exact probability method was used to explore the relevant factors affecting hippocampal injury and secondary epilepsy.Results: 1.In this study,the age of onset of children is generally small,the average age of onset is 1.5 ± 0.7 years old,the ratio of male and female is 2.1:1.During the course of the disease,19 children had convulsion status(55.9%),25 children had complicated history of febrile convulsion(73.5%).Most of the children had seizure frequency ≤ 3 times / year,accounting for 64.7%.23 cases(67.6%)had no abnormality in 2 times of hippocampal MRI,and 5 cases(14.7%)turned into epilepsy.At the first follow-up,the average illness time of disease was 1.1 years,and the average actual age was 2.3(1.6,3.9)years;at the second follow-up,the average illness time of disease was 2.2 years,the average actual age was 3.0(2.2,5.3)years,and the average interval between the two follow-up was 1.1 years.2.There was a positive correlation between the volume of bilateral hippocampus and the actual age(r = 0.68,P = 0.00).3.The average annual increment of left hippocampal volume(△V left side)is 0.36(0.23,0.51)cm3/y,the average annual increment of right hippocampal volume(△V right side)is 0.40(0.27,0.64)cm3/y,and the average annual increment of total hippocampal volume(△V total)is 0.75(0.50,1.17)cm3/y.There was no statistical difference between the left and right sides.4.There was a negative correlation between △V and the status epilepticus and illness time(r =-0.44,P = 0.01;r =-0.44,P = 0.01).5.There are 19 patients with status epilepticus,their△V left side is 0.32(0.11,0.41)cm3/y,△V right side is 0.36(0.24,0.42)cm3/y,there was no significant difference.Children whose seizure duration was between 5 to 15 minutes compared with ≥ 16 minutes,the △V was no statistically significant.6.According to the prognosis,the abnormal proportion of hippocampal MRI in febrile convulsion group was lower than that in non-febrile convulsion group and epilepsy group,the difference has no statistically significant.7.Hippocampal injury and secondary epilepsy were not related to gender,age,status of convulsion,history of complex febrile convulsion and other factors.Conclusion: 1.In children with recurrent febrile seizures,the volume of bilateral hippocampus gradually increased,and there was a positive correlation between the volume of hippocampus and the actual age.2.Compared with the children without the status of convulsion,the average annual growth rate of hippocampal volume is small.The status of convulsion will damage the development of hippocampal. |
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