有或无既往癫痫或癫痫持续状态的儿童难治性癫痫持续状态。
Refractory status epilepticus in children with and without prior epilepsy or status epilepticus.
作者信息
Sánchez Fernández Iván, Jackson Michele C, Abend Nicholas S, Arya Ravindra, Brenton James N, Carpenter Jessica L, Chapman Kevin E, Gaillard William D, Gaínza-Lein Marina, Glauser Tracy A, Goldstein Joshua L, Goodkin Howard P, Helseth Ashley, Kapur Kush, McDonough Tiffani L, Mikati Mohamad A, Peariso Katrina, Riviello James, Tasker Robert C, Topjian Alexis A, Wainwright Mark S, Wilfong Angus, Williams Korwyn, Loddenkemper Tobias
机构信息
From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ.
出版信息
Neurology. 2017 Jan 24;88(4):386-394. doi: 10.1212/WNL.0000000000003550. Epub 2016 Dec 23.
OBJECTIVE
To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).
METHODS
This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.
RESULTS
We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5-60] vs 16.5 [5-42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46-190] vs 50.5 [28-116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5-22.3] vs 20 [5-60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3-124] vs 65 [32.5-156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset.
CONCLUSIONS
Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.
目的
比较有或无癫痫既往诊断以及有或无癫痫持续状态（SE）病史的儿童难治性惊厥性癫痫持续状态（rSE）的管理及结局。
方法
这是一项于2011年6月至2016年5月对患有rSE的儿科患者（1个月至21岁）进行的前瞻性观察性描述性研究。
结果
我们纳入了189名参与者（53%为男性），中位（第25 - 75百分位数）年龄为4.2（1.3 - 9.6）岁。89名（47%）患者有癫痫既往诊断。34名（18%）患者有SE病史。有或无癫痫诊断的参与者首次使用苯二氮䓬类药物的时间相似（15 [5 - 60]分钟对16.5 [5 - 42.75]分钟，p = 0.858）。有癫痫诊断的患者首次使用非苯二氮䓬类（BZD）抗癫痫药物（AED）的时间较晚（93 [46 - 190]分钟对50.5 [28 - 116]分钟，p = 0.002），且接受至少一次持续输注的可能性较小（35/89 [39.3%]对57/100 [57%]，p = 0.03）。与无SE病史的患者相比，有SE病史的患者首次使用BZD的时间更早（8 [3.5 - 22.3]分钟对20 [5 - 60]分钟，p = 0.0073），尽管他们首次使用非BZD AED的时间相似（76.5 [45.3 - 124]分钟对65 [32.5 - 156]分钟，p = 0.749）。差异主要由院外发生rSE的患者驱动。
结论
我们的研究表明，有癫痫既往诊断的rSE儿童并未得到更及时的治疗；然而，SE病史与更及时给予终止发作药物有关。
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