Hopp Jennifer L, Sanchez Ana, Krumholz Allan, Hart George, Barry Elizabeth
Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street; Baltimore, MD 21201, USA.
Neurologist. 2011 Nov;17(6):325-9. doi: 10.1097/NRL.0b013e31822f688c.
Managing nonconvulsive status epilepticus (NCSE) poses many challenges that would benefit from additional early measures to predict patient outcomes. Here, we evaluate clinical and electroencephalographic responses to an acute antiepileptic drug trial as an added measure for predicting outcomes in patients presenting with suspected NCSE.
We analyzed all patients referred to our Neurology Service with suspected NCSE assessed by a standard acute intravenous (IV) benzodiazepine (BDZ) protocol. We correlated patients' clinical and electrographic (EEG) responses to the BDZ trial with their subsequent outcomes, including survival, recovery of consciousness, and functional status at hospital discharge.
From 1990 to 2001, we identified 62 patients with NCSE who were initially evaluated with an acute IV BDZ protocol trial. A favorable clinical response with improvement in consciousness was observed in 22 patients (35%), whereas 40 (65%) were clinical nonresponders. All of the positive clinical responders (100%) survived, recovered consciousness, and exhibited good functional outcomes. In contrast, outcomes were significantly poorer (P<0.001) for the clinical nonresponders; only 14 (35%) recovered consciousness and 22 (55%) survived, with 59% of those survivors demonstrating poor functional outcomes. EEG improvement with BDZs also predicted better outcome, but it was less robust than the clinical response, with better subsequent recovery of consciousness (P<0.05), but not functional outcome or survival.
This study demonstrates that a clinical and, to a lesser degree, EEG response to an acute trial of IV BDZs are predictive of subsequent outcome in patients with suspected NCSE, and warrant further consideration and investigation for assessing and managing patients.
管理非惊厥性癫痫持续状态（NCSE）面临诸多挑战，若能采取更多早期措施来预测患者预后将大有裨益。在此，我们评估急性抗癫痫药物试验的临床及脑电图反应，作为预测疑似NCSE患者预后的一项补充措施。
我们分析了所有因疑似NCSE转诊至我院神经科的患者，这些患者均按照标准急性静脉注射（IV）苯二氮䓬（BDZ）方案进行评估。我们将患者对BDZ试验的临床及脑电图（EEG）反应与其随后的预后进行关联，包括生存情况、意识恢复情况以及出院时的功能状态。
1990年至2001年期间，我们确定了62例接受急性IV BDZ方案试验初始评估的NCSE患者。22例患者（35%）出现意识改善的良好临床反应，而40例（65%）为临床无反应者。所有临床阳性反应者（100%）均存活、意识恢复且功能预后良好。相比之下，临床无反应者的预后明显更差（P<0.001）；只有14例（35%）意识恢复，22例（55%）存活，其中59%的存活者功能预后不良。BDZ治疗后EEG改善也预示着更好的预后，但不如临床反应显著，随后意识恢复更好（P<0.05），但对功能预后或生存情况无此影响。
本研究表明，对IV BDZs急性试验的临床反应以及程度较轻的EEG反应可预测疑似NCSE患者的后续预后，在评估和管理患者时值得进一步考虑和研究。
