Department of Neurology,Sanjay Gandhi Postgraduate Institute of Medical Sciences,Lucknow,India.
Can J Neurol Sci. 2017 Sep;44(5):538-546. doi: 10.1017/cjn.2017.28. Epub 2017 Apr 27.
Refractory status epilepticus (RSE) can influence the outcome of status epilepticus (SE). In the present study, we report the aetiology and predictors of outcomes of RSE in a developing country.
This is a prospective hospital-based study of SE patients (continuous seizures for five minutes or more). Those who had SE persisting after two antiepileptic drugs were defined as having RSE. We present the demographic information, duration, and type of SE, and we note its severity using the status epilepticus severity score (STESS), its aetiology, comorbidities and imaging findings. The outcome of RSE was defined as cessation of seizures and the condition upon discharge, as assessed by the modified Rankin Scale.
A total of 35 (42.5%) of our 81 patients had RSE. The median duration of SE before starting treatment was 2 hours (range=0.008-160 h). The most common causes of RSE were stroke in 5 (14.3%), central nervous system (CNS) infections in 12 (34.3%) and metabolic encephalopathies in 13 (37.1%) patients. Some 21 (60%) patients had comorbidities, and the STESS was favourable in 7 (20%) patients. A total of 14 (20%) patients died, but death was directly related to SE in only one of these. Some 10 patients had super-refractory status epilepticus, which was due to CNS infection in 5 (50%) and metabolic encephalopathy in 3 (30%). On multivariate analysis, an unfavourable STESS (p=0.05) and duration of SE before treatment (p=0.01) predicted RSE. Metabolic aetiology (p=0.05), mechanical ventilation (p60 years (p=0.003) were predictors of poor outcomes.
RSE was common (42.5%) among patients with SE in a tertiary care center in India. It was associated with high mortality and poor outcomes. Age above 60 years and metabolic aetiology were found to be predictors of poor outcomes.
难治性癫痫持续状态（RSE）可能会影响癫痫持续状态（SE）的预后。在本研究中，我们报告了在发展中国家 RSE 的病因和预后预测因素。
这是一项 SE 患者的前瞻性医院研究（连续发作五分钟或更长时间）。那些在两种抗癫痫药物后仍有 SE 的患者被定义为患有 RSE。我们提供了人口统计学信息、SE 的持续时间和类型，并使用癫痫持续状态严重程度评分（STESS）记录其严重程度、病因、合并症和影像学发现。RSE 的预后定义为停止发作和出院时的情况，通过改良 Rankin 量表进行评估。
在我们的 81 名患者中，共有 35 名（42.5%）患有 RSE。开始治疗前 SE 的中位持续时间为 2 小时（范围=0.008-160 小时）。RSE 最常见的病因是中风 5 例（14.3%）、中枢神经系统（CNS）感染 12 例（34.3%）和代谢性脑病 13 例（37.1%）。21 名（60%）患者有合并症，STESS 评分良好的有 7 名（20%）。共有 14 名（20%）患者死亡，但其中只有 1 名直接与 SE 相关。有 10 名患者患有超难治性癫痫持续状态，其中 5 名（50%）由 CNS 感染引起，3 名（30%）由代谢性脑病引起。多变量分析显示，不良的 STESS（p=0.05）和治疗前 SE 持续时间（p=0.01）是 RSE 的预测因素。代谢病因（p=0.05）、机械通气（p
