Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Seizure. 2017 Oct;51:43-49. doi: 10.1016/j.seizure.2017.07.009. Epub 2017 Jul 29.
This study investigated the predictive factors for progression from seizure-related endosulfan poisoning to status epilepticus (SE) and refractory SE (RSE). This study also investigated delayed neurologic sequelae in seizure-related endosulfan poisoning.
This retrospective, observational case series consisted of 73 patients who developed at least one seizure after endosulfan ingestion.
The progression rates from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE were 78.1% and 54.4%, respectively. The SE and RSE fatality rates were 19.2% and 41.9%, respectively. No patients reported the development of delayed neurological sequelae at least six months after discharge. Glasgow coma scale (GCS) score were identified as an independent factor for progression from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE. Lorazepam administration was independently associated with preventing progression from SE-related endosulfan poisoning to RSE.
Seizure-related endosulfan poisoning had higher progression rates to SE and RSE and higher fatality rates than other drug-induced seizures. However, delayed neurologic sequelae after discharge were not demonstrated. Due to the high progression rates from seizure-related endosulfan poisoning to SE and RSE and the absence of an established treatment for SE-related endosulfan poisoning, physicians should aggressively treat patients who experience a seizure after endosulfan poisoning and who present with decreased GCS score. Lorazepam should be considered a first-line anti-epileptic drug for controlling seizures in patients with endosulfan poisoning.
本研究旨在探讨与癫痫相关的硫丹中毒进展为癫痫持续状态（SE）和难治性 SE（RSE）的预测因素，并研究与癫痫相关的硫丹中毒后的迟发性神经后遗症。
本回顾性观察性病例系列研究纳入了 73 例因摄入硫丹后至少发生一次癫痫发作的患者。
从与癫痫相关的硫丹中毒进展为 SE 以及从 SE 相关的硫丹中毒进展为 RSE 的发生率分别为 78.1%和 54.4%。SE 和 RSE 的死亡率分别为 19.2%和 41.9%。出院后至少 6 个月无患者报告出现迟发性神经后遗症。格拉斯哥昏迷量表（GCS）评分被确定为与从与癫痫相关的硫丹中毒进展为 SE 以及从 SE 相关的硫丹中毒进展为 RSE 相关的独立因素。劳拉西泮的使用与预防从 SE 相关的硫丹中毒进展为 RSE 相关的独立相关。
与其他药物引起的癫痫发作相比，与癫痫相关的硫丹中毒具有更高的进展为 SE 和 RSE 的发生率和更高的死亡率。然而，出院后没有表现出迟发性神经后遗症。由于从与癫痫相关的硫丹中毒进展为 SE 和 RSE 的发生率较高，以及对于 SE 相关的硫丹中毒没有既定的治疗方法，医生应积极治疗在硫丹中毒后发生癫痫且 GCS 评分降低的患者。劳拉西泮应被视为控制硫丹中毒患者癫痫发作的一线抗癫痫药物。
