Dept. of Neurology, Klinikum Osnabrück, Osnabrück, Germany.
Epilepsy Behav. 2012 Mar;23(3):235-40. doi: 10.1016/j.yebeh.2011.12.020. Epub 2012 Feb 16.
Status epilepticus (SE) is a neurological emergency usually requiring immediate medical treatment. Due to the lack of adequate studies, treatment guidelines and their application vary between countries and institutions. We intended to analyze current treatment of SE in a German community hospital.
We retrospectively identified patients from a large community hospital in northern Germany who had been diagnosed with SE between August 2008 and December 2010. Their charts were reviewed regarding sociodemographic variables, treatment and outcome.
We studied the first SE episode in 172 patients with a median age of 69 years (range 18-90 years). The etiology was acute symptomatic in 30 patients, progressive symptomatic in 22 patients and remote symptomatic in 120 patients. Presentation was generalized convulsive in 60 patients, non-convulsive in 72 patients and simple motor/aura in 40 patients. Median latency from onset to treatment start was 0.75 h (range 0.2-336 h). Initial treatment had a success rate (SR) of 40%. Second line treatment had a success rate of 54%. In patients whose seizures were refractory to the first two drugs, success rates were between 31% and 55%, with only a minority of the patients receiving established drugs such as phenytoin or barbiturates. Multivariate analysis revealed non-convulsive semiology as the only factor significantly associated with refractoriness. SE could be terminated in 95% of the patients and in-hospital mortality was 10%. Benzodiazepines and phenytoin had the most severe side effects.
Status epilepticus can be terminated successfully and with low in-hospital mortality in the vast majority of the patients treated in a large community hospital. The success rate of each treatment step is between 30% and 55% regardless of the substances used.
癫痫持续状态（SE）是一种神经急症，通常需要立即进行医疗治疗。由于缺乏充分的研究，治疗指南及其应用在国家和机构之间存在差异。我们旨在分析德国一家社区医院中 SE 的当前治疗情况。
我们从德国北部一家大型社区医院回顾性地确定了 2008 年 8 月至 2010 年 12 月期间被诊断为 SE 的患者。回顾了他们的图表，以了解社会人口统计学变量、治疗和结果。
我们研究了 172 例 SE 患者的首次 SE 发作，中位年龄为 69 岁（范围 18-90 岁）。病因在 30 例患者中为急性症状性，在 22 例患者中为进行性症状性，在 120 例患者中为远隔症状性。表现为全身性强直阵挛发作的有 60 例，非惊厥性的有 72 例，单纯运动/先兆的有 40 例。从发病到开始治疗的中位潜伏期为 0.75 小时（范围 0.2-336 小时）。初始治疗的成功率（SR）为 40%。二线治疗的成功率为 54%。在最初两种药物治疗无效的患者中，成功率在 31%-55%之间，只有少数患者接受了苯妥英或巴比妥等既定药物。多变量分析显示非惊厥性半侧性是与难治性相关的唯一显著因素。95%的患者可以终止 SE，住院死亡率为 10%。苯二氮䓬类和苯妥英的副作用最严重。
在大型社区医院治疗的绝大多数患者中，可以成功终止 SE，且住院死亡率低。无论使用何种药物，每个治疗步骤的成功率在 30%-55%之间。
