Department of Clinical Neurophysiology, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.
Clin Neurophysiol. 2012 Feb;123(2):244-51. doi: 10.1016/j.clinph.2011.06.020. Epub 2011 Jul 19.
Nonconvulsive status epilepticus (NCSE) represents an important percentage of status epilepticus in adults, but detailed studies of both NCSE proper and comatose NCSE are lacking. We retrospectively analyzed a prospectively collected series of 50 adult patients with a diagnosis of NCSE whose electroencephalograms (EEGs) have been interpreted for a period of 10 years by the same investigator.
Two groups, NCSE proper and comatose NCSE were considered. All clinical, EEGs, neuroimaging data, antiepileptic treatment and outcome were analyzed.
Thirty-two patients (64%) had NCSE proper and 18 patients (36%) comatose NCSE. The mean age was 56 years (range 19-89 years). Fourteen (44%) were diagnosed with absence status epilepticus (ASE), one had simple partial status epilepticus (SPSE) and 17 (53%) had complex partial status epilepticus (CPSE). The mean episode duration (33.2±13.9 versus 60.6±34.0), mean number of antiepileptic drugs (AEDs) (1.46±0.5 versus 2.77±1.39) and neuroimaging anomalies (50% versus 16%) was significantly greater in the partial/focal NCSE proper subgroup than in the ASE subgroup. The mean age (56.0±19.9 versus 69.4±12.1), number of elderly individuals (46% versus 77%), mean duration of the episode (49.1±30.4 versus 153.3±142.6), mortality rate (6% versus 61%) and admission at ICU (18% versus 83%) was significantly higher in the comatose NCSE group than in the NCSE proper group (p<.05). Conversely, a previous history of chronic epilepsy was significantly more frequent (62% versus 5.6%) in the NCSE proper group. The mean duration of comatose NCSE was significantly greater in the surviving subgroup (102.5±29.1 versus 233.1±65.3; p<.05).
Our study demonstrates that there are sufficient differences regarding age of onset, history of previous epilepsy, episode duration, mortality rate and clinical presentation between NCSE proper and comatose NCSE to recommend adoption in clinical practice. These results should be taken into account when developing future classifications and therapeutic trials on NCSE.
A distinction between NCSE proper (ambulatory forms of NCSE) and comatose NCSE is useful in the clinical practice and, therefore, it should taken in account in the design of future investigations on this heterogeneous epileptic condition.
非惊厥性癫痫持续状态（NCSE）是成人癫痫持续状态的一个重要比例，但对 NCSE 本身和昏迷性 NCSE 的详细研究还很缺乏。我们回顾性分析了 50 例经同一研究者连续 10 年对脑电图（EEG）进行解释的成人诊断为 NCSE 的患者的前瞻性收集系列。
考虑了两组，NCSE 本身和昏迷性 NCSE。分析了所有的临床、EEG、神经影像学数据、抗癫痫治疗和结果。
32 例（64%）为 NCSE 本身，18 例（36%）为昏迷性 NCSE。平均年龄为 56 岁（19-89 岁）。14 例（44%）诊断为失神性癫痫持续状态（ASE），1 例为单纯部分性癫痫持续状态（SPSE），17 例（53%）为复杂部分性癫痫持续状态（CPSE）。部分/局灶性 NCSE 本身亚组的发作持续时间（33.2±13.9 与 60.6±34.0）、抗癫痫药物（AEDs）的平均数量（1.46±0.5 与 2.77±1.39）和神经影像学异常（50%与 16%）明显大于 ASE 亚组。年龄（56.0±19.9 与 69.4±12.1）、老年患者比例（46%与 77%）、发作持续时间（49.1±30.4 与 153.3±142.6）、死亡率（6%与 61%）和 ICU 入院率（18%与 83%）在昏迷性 NCSE 组明显高于 NCSE 本身组（p<.05）。相反，NCSE 本身组既往有慢性癫痫史的比例明显更高（62%与 5.6%）。存活亚组昏迷性 NCSE 的持续时间明显较长（102.5±29.1 与 233.1±65.3；p<.05）。
我们的研究表明，NCSE 本身和昏迷性 NCSE 之间在发病年龄、既往癫痫史、发作持续时间、死亡率和临床表现方面存在足够的差异，建议在临床实践中采用。在制定关于 NCSE 的未来分类和治疗试验时，应该考虑到这些结果。
NCSE 本身（NCSE 的活动形式）和昏迷性 NCSE 之间的区别在临床实践中是有用的，因此，在设计关于这种异质癫痫状态的未来研究时应该考虑到这一点。
