Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India.
J Neurol Sci. 2010 Mar 15;290(1-2):60-5. doi: 10.1016/j.jns.2009.11.007. Epub 2009 Dec 2.
To analyse the underlying causes, therapeutic response and outcomes of convulsive refractory status epilepticus (RSE).
This retrospective analysis was carried on 98 patients with RSE (age: 16.9+/-14.5 years). All had received a combination of parenteral benzodiazepine and phenytoin or phenobarbitone followed by other anti-epileptic drugs (AEDs). The clinical, EEG, imaging features of convulsive RSE and long-term seizure outcome were analysed.
Seventy six patients had de novo RSE for the first time in life. The mean duration of RSE, before and during NICU admission was 3.4+/-3.2 days and 2.9+/-2.4 days respectively. The mean duration of NICU stay and mechanical ventilation was 17.4+/-14.5 was 14.4+/-12.8 days respectively. The precipitating factors included viral fever - 13, AEDs stoppage - 7 and alcohol - 1. EEG was abnormal in 81.5% of patients. CT and MRI were abnormal in 63.4% and 82.3% respectively. Thirty-four patients died and compared to those surviving, patients were older, had lesser duration of NICU stay and elevated CSF protein. Dependence for activities of daily living (ADL) at discharge was: recovered - 29, mild to moderate - 13 and severe - 22. Seizure outcome in 64 patients after 43.5+/-58.2 weeks were - seizure-free: 65.6%, one seizure: 21.8%, >1 seizure/month: 14.1%, and seizure recurrence requiring admission: 1.5%. After six and twelve months of follow up, the long-term seizure outcome were: seizure-free: 48.3% and 28.6%; one seizure: 27.6% and 38.1%; >1 seizure/month: 20.7% and 28.6%; and seizure recurrence requiring admission: 3.4% and 4.7% respectively. Among those survived 49 de novo RSE, about one-third developed post-SE symptomatic seizures after 30.1+/-54.4 weeks.
Seizures could still be controlled in two-thirds of patients with convulsive RSE. About 30% of patients achieved long-term seizure freedom.
分析惊厥性难治性癫痫持续状态（RSE）的潜在原因、治疗反应和转归。
本回顾性分析纳入了 98 例 RSE 患者（年龄：16.9+/-14.5 岁）。所有患者均接受了静脉用苯二氮䓬类药物和苯妥英或苯巴比妥联合其他抗癫痫药物（AEDs）治疗。分析了惊厥性 RSE 的临床、脑电图、影像学特征和长期发作结局。
76 例患者为首次生命中新发 RSE。RSE 持续时间，入 NICU 前和入 NICU 时的平均值分别为 3.4+/-3.2 天和 2.9+/-2.4 天。NICU 住院时间和机械通气时间的平均值分别为 17.4+/-14.5 天和 14.4+/-12.8 天。诱发因素包括病毒发热-13 例、AED 停药-7 例和酒精-1 例。81.5%的患者脑电图异常。CT 和 MRI 异常的比例分别为 63.4%和 82.3%。34 例患者死亡，与存活患者相比，死亡患者年龄更大，NICU 住院时间更短，CSF 蛋白水平更高。出院时日常生活活动（ADL）的依赖程度为：恢复-29 例、轻度至中度-13 例、重度-22 例。64 例患者在 43.5+/-58.2 周后进行了癫痫发作评估，结果为：无癫痫发作：65.6%，单次发作：21.8%，每月>1 次发作：14.1%，再次入院需要治疗的癫痫发作：1.5%。6 个月和 12 个月随访时的长期癫痫发作结局为：无癫痫发作：48.3%和 28.6%；单次发作：27.6%和 38.1%；每月>1 次发作：20.7%和 28.6%；再次入院需要治疗的癫痫发作：3.4%和 4.7%。在幸存的 49 例新诊断的 RSE 患者中，约三分之一在 30.1+/-54.4 周后出现 SE 后症状性癫痫发作。
约三分之二的惊厥性 RSE 患者的癫痫发作仍可得到控制。约 30%的患者达到了长期无癫痫发作。
