Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study

被引:96
作者
McIntosh, Anne M. [5 ,6 ]
McMahon, Jacinta [5 ,6 ]
Dibbens, Leanne M. [2 ,3 ]
Iona, Xenia [3 ]
Mulley, John C. [1 ,3 ]
Scheffer, Ingrid E. [4 ,5 ,6 ]
Berkovic, Samuel F. [5 ,6 ]
机构
[1] Univ Adelaide, Sch Mol & Biomed Sci Genet, Adelaide, SA 5005, Australia
[2] Univ Adelaide, Sch Paediat & Reprod Hlth Paediat, Adelaide, SA 5005, Australia
[3] SA Pathol Womens & Childrens Hosp, Epilepsy Res Program, Adelaide, SA, Australia
[4] Univ Melbourne, Royal Childrens Hosp, Dept Paediat, Melbourne, Vic 3010, Australia
[5] Univ Melbourne, Dept Med Neurol, Melbourne, Vic 3010, Australia
[6] Univ Melbourne, Epilepsy Res Ctr, Melbourne, Vic 3010, Australia
基金
英国医学研究理事会;
关键词
SEVERE MYOCLONIC EPILEPSY; WHOLE-CELL PERTUSSIS; CHANNEL GENE SCN1A; DE-NOVO MUTATIONS; DT IMMUNIZATIONS; ENCEPHALOPATHY; SEIZURES; INFANCY; COMPLICATIONS; DELETIONS;
D O I
10.1016/S1474-4422(10)70107-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Pertussis vaccination has been alleged to cause an encephalopathy that involves seizures and subsequent intellectual disability. In a previous retrospective study, 11 of 14 patients with so-called vaccine encephalopathy had Dravet syndrome that was associated with de-novo mutations of the sodium channel gene SCN1A. In this study, we aimed to establish whether the apparent association of Dravet syndrome with vaccination was caused by recall bias and, if not, whether vaccination affected the onset or outcome of the disorder. Methods We retrospectively studied patients with Dravet syndrome who had mutations in SCN1A, whose first seizure was a convulsion, and for whom validated source data were available. We analysed medical and vaccination records to investigate whether there was an association between vaccination and onset of seizures in these patients. Patients were separated into two groups according to whether seizure onset occurred shortly after vaccination (vaccination-proximate group) or not (vaccination-distant group). We compared clinical features, intellectual outcome, and type of SCN1A mutation between the groups. Findings Dates of vaccination and seizure onset were available from source records for 40 patients. We identified a peak in the number of patients who had seizure onset within 2 days after vaccination. Thus, patients who had seizure onset on the day of or the day after vaccination (n=12) were included in the vaccination-proximate group and those who had seizure onset 2 days or more after vaccination (n=25) or before vaccination (n=3) were included in the vaccination-distant group. Mean age at seizure onset was 18.4 weeks (SD 5.9) in the vaccination-proximate group and 26.2 weeks (8.1) in the vaccination-distant group (difference 7.8 weeks, 95% CI 2.6-13.1; p=0.004). There were no differences in intellectual outcome, subsequent seizure type, or mutation type between the two groups (all p values >0.3). Furthermore, in a post-hoc analysis, intellectual outcome did not differ between patients who received vaccinations after seizure onset and those who did not. Interpretation Vaccination might trigger earlier onset of Dravet syndrome in children who, because of an SCN1A mutation, are destined to develop the disease. However, vaccination should not be withheld from children with SCN1A mutations because we found no evidence that vaccinations before or after disease onset affect outcome.
引用
收藏
页码:592 / 598
页数:7
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