Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Switzerland.
Epilepsy Res. 2011 Sep;96(1-2):140-50. doi: 10.1016/j.eplepsyres.2011.05.018. Epub 2011 Jun 14.
Status epilepticus is one of the most important neurological emergencies and requires immediate therapy and admission to the intensive care unit. We hypothesized that nonconvulsive and subtle status epilepticus are more frequent than reported.
This observational cohort study describes types, courses, duration, length of hospital stay, outcome and case fatality rate of status epilepticus in adults in relation to demographic and clinical variables. It was conducted in an intensive care unit of a tertiary care center over three years.
111 status epilepticus episodes had a median duration of 48h. Hospitalization length was 18±15.3 days. 81% of the status epilepticus episodes were nonconvulsive and subtle. Case fatality rate was 17%. Age over 70 years had independent positive influence on status epilepticus course (OR: 5.135; p=0.0029). Hospital stay increased by 1.13h with each additional hour of status epilepticus (p=0.02). Subtle status epilepticus was a risk factor for refractoriness (p=0.0065).
Prevalence of nonconvulsive and subtle status epilepticus was higher than reported, emphasising the importance of clinical awareness. Older age was associated with more favorable course. This unexpected and contradictory result has to be taken into account during therapeutic interventions in the elderly and should warn from early resignation regarding treatment.
癫痫持续状态是最重要的神经急症之一，需要立即进行治疗并收入重症监护病房。我们假设非惊厥性和轻微的癫痫持续状态比报告的更为常见。
本观察性队列研究描述了成人癫痫持续状态的类型、病程、持续时间、住院时间、结果和病死率与人口统计学和临床变量的关系。该研究在一家三级护理中心的重症监护病房进行了三年。
111 例癫痫持续状态发作的中位持续时间为 48 小时。住院时间为 18±15.3 天。81%的癫痫持续状态发作是非惊厥性和轻微的。病死率为 17%。年龄超过 70 岁对癫痫持续状态的病程有独立的正向影响（OR：5.135；p=0.0029）。癫痫持续状态每增加 1 小时，住院时间就会增加 1.13 小时（p=0.02）。轻微癫痫持续状态是难治性的危险因素（p=0.0065）。
非惊厥性和轻微癫痫持续状态的患病率高于报告的水平，这强调了临床意识的重要性。年龄较大与较好的病程相关。这一意外和矛盾的结果在老年患者的治疗干预中需要加以考虑，并应警惕早期放弃治疗。
