PROPOSAL OF A NEW METHOD IN THE PROGNOSTIC STUDY OF NEUROPEDIATRIC DISORDERS : A Prognostic Study in Terms of Developmental Epidemiology Focussing on Convulsive Seizure as an Example
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The aim of this study is to propose a new method in the prognostic study of neuropediatric disorders. As an example, the authors studied the prognosis of convulsive seizure in early childhood. It is very difficult to conduct a prospective follow-up survey of convulsive seizure detected primarily at the Well Child Clinic (WCC) sponsored by towns and cities. Therefore, there are only a few prospective follow-up studies of prognosis of convulsive seizure in early childhood detected at the WCC. In order to solve this problem, a unique method was adopted in our survey. Among 1,162 three-year-old children who were seen at the WCC in A City, Ibaraki Prefecture, 110 children had a history of convulsive seizure in early childhood. The authors considered this to be a "natural distribution" (ND) of convulsive seizure in early childhood, and this ND group should be followed up. Since it is impossible, the authors studied another group, a "quasi natural distribution" (see below) instead of this ND group of WCC. Each case of 110 WCC children having convulsive seizure was matched with a patient of the neuro pediatric clinic (NCP) cases. To match the convulsive seizure cases of the WCC and those of NPC cases, the following indices were used for the sake of convenience: 1) sex, 2) age at initial seizure, 3) frequency of seizure up to 3 and a half years old, 4) febrile or non febrile convulsion, and 5) level of DQ (developmental quotient) of MN-developmental screening test. The authors were able to form 90 matched pairs of WCC children (A_0 group) and NPC children (A_1 group). The authors considered the Al group as a suitable substitute group to study the prognosis of convulsive seizure in early childhood and called this Al group "quasi natural distribution" (QND) group. Among 90 (A_1 group) 78 cases (86.7%) had their last seizure before the age of 3. After age of 6 years, seizure occurred in only 5 cases (5.6%). As for the school evaluation report, only 6 cases (6.8%) out of 88 cases (A_1 group) scored below average, and 39 cases (44.3%) scored above average. The result of this study indicates that, in general, the prognosis of convulsive seizure in early childhood is good although some exceptional cases have chronic recurrence of convulsive seizures after age of 7. This study is a kind of study in developmental epidemiology?). The authors thus propose a new method facilitating the prognostic study of neuropediatric disorders and would like to emphasize that the MN-developmental screening test (devised by the authors' research group) was used as an index in this study to control the quality of the subjects.
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