Cardoso Ingrid, Acevedo Keryma, Hernández Marta, Santin Julia, Moya Pedro, Godoy Jaime, Castillo Andrés, Soto Pilar, Mesa Tomás
División de Pediatría; Unidad de Neurología.
Rev Neurol. 2013 Apr 16;56(8):401-8.
Patients with refractory status epilepticus (RSE) have high morbidity and mortality rates, are hospitalised for longer periods of time, suffer greater neurological damage and progress to symptomatic epilepsy. Continuous electroencephalogram (cEEG) monitoring is a valuable aid in the early detection of RSE, especially in the case of non-convulsive status epilepticus (NCSE). In this study we describe the clinical characteristics, treatment and use of cEEG in paediatric patients with RSE.
A retrospective study was conducted at the Hospital Clinico de la Pontificia Universidad Catolica de Chile between November 2005 and March 2011 in patients aged between 1 month and 15 years diagnosed with RSE and cEEG. Demographic characteristics, baseline and final conditions, and therapy were recorded.
A total of 15 patients, 12 of whom were males, with a mean age of 4 years (1.5 months-13 years) were identified. Eight patients had a history of epilepsy. The most frequent aetiologies were progressive symptomatic and acute symptomatic. Convulsive epileptic status (CSE) was present in 11 patients and NCSE in the other four. During the cEEG, six of the 11 patients with CSE later progressed to NCSE. The mean amount of time with RSE was 10.2 days. Of the 15 patients, 13 responded to anticonvulsive drugs and the main secondary complications were respiratory depression and hypotension. Patients with CSE tended to evolve in a more torpid manner than patients with NCSE. On discharge from hospital, 13 patients (86.6%) presented new neurological deficit or difficult-to-manage epilepsy, one still had RSE and one died (6%).
The aggregate neurological morbidity and mortality rates of RSE were high. The use of cEEG monitoring should be considered for use in the management of such cases of status epilepticus.
难治性癫痫持续状态（RSE）患者的发病率和死亡率很高，住院时间更长，神经损伤更严重，并会发展为症状性癫痫。连续脑电图（cEEG）监测有助于早期发现RSE，尤其是在非惊厥性癫痫持续状态（NCSE）的情况下。在本研究中，我们描述了小儿RSE患者的临床特征、治疗及cEEG的应用。
于2005年11月至2011年3月在智利天主教大学临床医院对年龄在1个月至15岁之间、诊断为RSE且进行了cEEG监测的患者进行了一项回顾性研究。记录了人口统计学特征、基线和最终状况以及治疗情况。
共确定了15例患者，其中12例为男性，平均年龄4岁（1.5个月至13岁）。8例患者有癫痫病史。最常见的病因是进行性症状性和急性症状性。11例患者出现惊厥性癫痫持续状态（CSE），另外4例为NCSE。在cEEG监测期间，11例CSE患者中有6例后来发展为NCSE。RSE的平均持续时间为10.2天。15例患者中有13例对抗惊厥药物有反应，主要的次要并发症是呼吸抑制和低血压。CSE患者的病情发展往往比NCSE患者更为缓慢。出院时，13例患者（86.6%）出现了新的神经功能缺损或难治性癫痫，1例仍患有RSE，1例死亡（6%）。
RSE的总体神经发病率和死亡率很高。在处理此类癫痫持续状态病例时应考虑使用cEEG监测。
