Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
JAMA Neurol. 2013 Jan;70(1):72-7. doi: 10.1001/jamaneurol.2013.578.
To further characterize the demographics, outcomes, and prognostic factors for refractory status epilepticus (RSE).
Retrospective analysis of all the episodes of RSE treated between January 1, 1999, and August 30, 2011.
Neurointensive care unit within a tertiary referral center, Mayo Clinic, Rochester, Minnesota.
Refractory status epilepticus was defined as generalized convulsive or nonconvulsive status epilepticus (SE) that continued despite initial first- and second-line therapies. Exclusion criteria were aged younger than 18 years, anoxic/myoclonic SE, psychogenic SE, simple partial SE, and absence SE.
Functional outcome was defined by modified Rankin scale (mRS) dichotomized into good (mRS, 0-3) and poor (mRS, 4-6). Functional decline was defined as a change in mRS greater than 1 from hospital admission to discharge.
We identified 63 consecutive episodes of non-anoxic RSE in 54 patients. Anesthetic agents were used in 55 episodes (87.30%), and duration of drug-induced coma was (mean [SD]) 11.0 (17.9) days. In-hospital mortality was 31.75% (20 of 63 episodes). Poor functional outcome at discharge occurred in 48 of 63 episodes (76.19%). Hospital length of stay was (mean [SD]) 27.7 (37.3) days. Duration of drug-induced coma (P=.03), arrhythmias requiring intervention (P=.01), and pneumonia (P=.01) were associated with poor functional outcome. Prolonged mechanical ventilation was associated with mortality (P=.04). Seizure control without suppression-burst or isoelectric electroencephalogram predicted good functional recovery (P=.01). Age, history of epilepsy, previous SE, type of SE, and anesthetic drug used were not associated with functional outcome.
Three-quarters of patients with RSE have a poor outcome. Achieving control of the SE without requiring prolonged drug-induced coma or severe electroencephalographic suppression portends better prognosis.
进一步描述难治性癫痫持续状态（RSE）的患者特征、结局和预后因素。
对 1999 年 1 月 1 日至 2011 年 8 月 30 日期间治疗的所有 RSE 发作进行回顾性分析。
明尼苏达州罗切斯特市梅奥诊所的三级转诊中心神经重症监护病房。
难治性癫痫持续状态定义为全身性强直阵挛或非惊厥性癫痫持续状态（SE），尽管初始一线和二线治疗仍持续发作。排除标准为年龄小于 18 岁、缺氧/肌阵挛性 SE、心因性 SE、单纯部分性 SE 和失神性 SE。
功能结局定义为改良 Rankin 量表（mRS）分为良好（mRS，0-3）和不良（mRS，4-6）。功能下降定义为从入院到出院 mRS 评分变化大于 1。
我们在 54 例患者中确定了 63 例非缺氧性 RSE 的连续发作。55 例（87.30%）使用了麻醉剂，诱导昏迷的持续时间（平均值[标准差]）为 11.0（17.9）天。住院死亡率为 31.75%（63 例中的 20 例）。63 例中 48 例（76.19%）出院时功能不良。住院时间为 27.7（37.3）天。诱导昏迷时间（P=.03）、需要干预的心律失常（P=.01）和肺炎（P=.01）与不良功能结局相关。长时间机械通气与死亡率相关（P=.04）。无抑制爆发或等电脑电图的癫痫发作控制预测良好的功能恢复（P=.01）。年龄、癫痫病史、既往 SE、SE 类型和使用的麻醉药物与功能结局无关。
四分之三的 RSE 患者预后不良。在不要求长时间药物诱导昏迷或严重脑电图抑制的情况下控制 SE 预示着更好的预后。
