Barzegar Mohammad, Mahdavi Mohammad, Galegolab Behbehani Afshin, Tabrizi Aidin
Pediatric Neurology Department Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Pediatric Cardiologist, Pediatric Cardiology ward, Sheid Rajaee Hospital, Iran University of Medical Sciences, Tehran, Iran.
Iran J Child Neurol. 2015 Fall;9(4):24-31.
Refractory status epilepticus (RSE) is a life-threatening disease in children wherein the patient's convulsive seizures do not respond to adequate initial anticonvulsants. RSE is associated with high rate of mortality and morbidity. This study was aimed to survey the risk factors leading status epilepticus (SE) to RSE in children, and their early outcome.
MATERIALS & METHODS: Patients with SE hospitalized in Tabriz Children's Hospital, Iran were studied during the years 2007 and 2008 with regard to their clinical profile, etiology, the treatment methods available to them and their outcome upon release from the hospital.
Among 132 patients with SE, 53 patients (40.15%) suffered from RSE. Acute symptomatic etiology was a risk factor responsible for developing RSE in the patient (P=0.004). Encephalitis was the most common etiology of acute symptomatic SE. There was no significant relationship observed between RSE and the patients' age, gender, date of initial drug intake and type of seizure. The mortality rate was 8.3% and a new neurological deficit occurred in 25.7% of cases. None of RSE with encephalitis returned to the baseline status. Mortality and morbidity rates were significantly higher in children with RSE than in those with SE (P=0.006).
Etiology of SE significantly influenced prognosis of it with significant incidence of RSE in acute symptomatic group. Because acute neurological insult such as encephalitis and meningitis are common causes of RSE in children, properly management of them is necessary to avoid permanent brain damage.
难治性癫痫持续状态（RSE）是一种危及儿童生命的疾病，患者的惊厥性癫痫发作对足够的初始抗惊厥药物无反应。RSE与高死亡率和高发病率相关。本研究旨在调查导致儿童癫痫持续状态（SE）发展为RSE的危险因素及其早期结局。
对2007年和2008年在伊朗大不里士儿童医院住院的SE患者的临床特征、病因、可用治疗方法及出院结局进行了研究。
在132例SE患者中，53例（40.15%）患有RSE。急性症状性病因是导致患者发生RSE的危险因素（P = 0.004）。脑炎是急性症状性SE最常见的病因。未观察到RSE与患者年龄、性别、首次用药日期及癫痫发作类型之间存在显著关系。死亡率为8.3%，25.7%的病例出现了新的神经功能缺损。脑炎所致的RSE患者无一恢复至基线状态。RSE患儿的死亡率和发病率显著高于SE患儿（P = 0.006）。
SE的病因显著影响其预后，急性症状性组RSE的发生率较高。由于脑炎和脑膜炎等急性神经损伤是儿童RSE的常见原因，因此对其进行恰当管理对于避免永久性脑损伤很有必要。
