Hassan Haseeb, Rajiv Keni Ravish, Menon Ramshekhar, Menon Deepak, Nair Muralidharan, Radhakrishnan Ashalatha
R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
Epileptic Disord. 2016 Jun 1;18(2):163-72. doi: 10.1684/epd.2016.0832.
Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1±20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non-convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second-line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Aetiology was the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common. Treatment delay was frequent and adversely affected the outcome.
癫痫持续状态是一种具有显著发病率和死亡率的神经系统急症。本研究描述了一个发展中国家三级转诊中心癫痫持续状态的临床特征、治疗及预后预测因素，旨在突出与西方世界现有数据的异同。对2000年1月至2010年9月期间前瞻性保存记录中接受癫痫持续状态治疗的患者数据进行回顾性分析。研究了人口统计学数据、临床特征及检查（包括神经影像学和脑电图）、病因、治疗及预后，并与西方世界的可用数据进行比较。分析包括84例患者的108次发作事件。72例患者（86%）接受了单次癫痫持续状态发作治疗，12例患者（14%）接受了多次癫痫持续状态发作治疗，每位患者发作次数为2至6次。平均年龄为24.1±20.3岁，63%为男性。癫痫持续状态的类型包括惊厥性癫痫持续状态98例（90.7%）、非惊厥性癫痫持续状态7例（6.5%）、肌阵挛性癫痫持续状态3例（2.8%）。大多数发作事件（60%）为远隔症状性，16%为急性症状性，16%病因不明，8%为进行性症状性。85次发作事件（79%）中，癫痫持续状态可通过一线和二线药物终止。其余23次发作事件（21%）进展为难治性癫痫持续状态，其中13例（56%）通过持续静脉输注咪达唑仑得到控制。病死率为11%，22%报告有神经后遗症，67%恢复至基线状态。急性症状性状态、年龄较大、入院时意识改变及住院延迟是预后不良的预测因素。与西方世界的报告一样，病因是癫痫持续状态预后的最重要决定因素，最常见的是继发于胶质增生的远隔症状性病因。治疗延迟很常见，且对预后产生不利影响。
