Cooper Alex D, Britton Jeffrey W, Rabinstein Alejandro A
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Arch Neurol. 2009 Dec;66(12):1505-9. doi: 10.1001/archneurol.2009.273.
To determine the functional and cognitive outcomes of patients with prolonged refractory status epilepticus (PRSE) lasting 7 or more days despite the use of anesthetic agents for seizure suppression.
Retrospective analysis.
St Mary's Hospital, Mayo Clinic, Rochester, Minnesota.
Fourteen patients with PRSE.
Hospital follow-up interview.
Survival rate of PRSE and functional and cognitive outcome of surviving patients based on the modified Rankin Scale (mRS) and Telephone Interview for Cognitive Status (TICS).
Forty-three percent of patients (6 of 14) died during hospitalization for PRSE, and 57% (8 of 14) had died by the last follow-up. Of the 6 surviving patients, 4 showed improvement and 2 showed no change in mRS score (median mRS change, -1; range, 0 to -3). Owing to preexisting cognitive deficits, 1 patient could not complete the TICS. The 5 remaining patients scored a median of 34 on the TICS (range, 30-37; reference TICS score, >or=31; maximum TICS score, 41). Age, sex, PRSE duration, and etiology were not associated with chance of survival.
Despite the high mortality rate, survival with meaningful functional and cognitive recovery is possible after PRSE. Prolonged duration of status epilepticus alone should not be considered a reason to discontinue treatment.
确定尽管使用了麻醉药物来抑制癫痫发作，但癫痫持续状态持续7天或更长时间的难治性癫痫持续状态（PRSE）患者的功能和认知结局。
回顾性分析。
明尼苏达州罗切斯特市梅奥诊所圣玛丽医院。
14例PRSE患者。
医院随访访谈。
基于改良Rankin量表（mRS）和认知状态电话访谈（TICS）评估PRSE患者的生存率以及存活患者的功能和认知结局。
43%的患者（14例中的6例）在因PRSE住院期间死亡，57%（14例中的8例）在最后一次随访时死亡。在6例存活患者中，4例mRS评分有所改善，2例无变化（mRS评分中位数变化为-1；范围为0至-3）。由于存在既往认知缺陷，1例患者无法完成TICS。其余5例患者TICS评分中位数为34（范围为30 - 37；参考TICS评分≥31；TICS最高评分为41）。年龄、性别、PRSE持续时间和病因与生存机会无关。
尽管死亡率高，但PRSE后仍有可能实现有意义的功能和认知恢复的存活。不应仅将癫痫持续状态的持续时间延长视为停止治疗的理由。
