Yuan Fang, Jia Ruihua, Gao Qiong, Yang Fang, Yang Xiai, Jiang Yongli, Li Wen, Marcuse Lara V, Jiang Wen
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
The Mount Sinai Epilepsy Center, The Mount Sinai School of Medicine, New York, New York, USA.
Eur Neurol. 2018;79(5-6):325-332. doi: 10.1159/000490900. Epub 2018 Jul 9.
Drug-resistant epilepsy (DRE) is a common and serious consequence of convulsive status epilepticus (CSE). Little is known on the early prediction of DRE development after CSE. Our aim was to identify independent DRE predictors in patients with CSE.
One hundred and forty consecutive patients identified with CSE in a tertiary academic hospital between March 2008 and January 2015 were reviewed. Demographics, clinical features, serum albumin neuroimaging, and electroencephalogram characteristics were collected and analyzed. Independent predictors of DRE were identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to quantify the predictive validity of all the risk factors.
After a median 62-month observation period, 91 patients were enrolled into this study. Thirty-seven (40.7%) patients did not have DRE, 22 (24.2%) developed DRE, and 32 (35.2%) were dead. History of epilepsy (OR 9.17, 95% CI 1.77-49.22, p = 0.010), status epilepticus duration ≥24 h (OR 4.82, 95% CI 1.04-22.37, p = 0.044), and cortical or hippocampal abnormalities on neuroimaging (OR 9.49, 95% CI 1.90-47.50, p = 0.006) were independent predictors of DRE after CSE. A combination of these 3 variables yielded an area under the ROC curve of 0.77 (0.65-0.89).
History of epilepsy, longer SE duration, and cortical or hippocampal abnormalities on neuroimaging are early predictors for the development of DRE after CSE. Further studies are needed to assess whether a more aggressive treatment will reduce the likelihood of DRE development in these high-risk patients.
耐药性癫痫（DRE）是惊厥性癫痫持续状态（CSE）常见且严重的后果。关于CSE后DRE发生的早期预测知之甚少。我们的目的是确定CSE患者中DRE的独立预测因素。
回顾了2008年3月至2015年1月在一家三级学术医院连续确诊的140例CSE患者。收集并分析了人口统计学、临床特征、血清白蛋白、神经影像学和脑电图特征。使用多因素逻辑回归确定DRE的独立预测因素。采用受试者工作特征（ROC）曲线来量化所有危险因素的预测效度。
经过中位62个月的观察期，91例患者纳入本研究。37例（40.7%）患者无DRE，22例（24.2%）发生DRE，32例（35.2%）死亡。癫痫病史（比值比9.17，95%可信区间1.77 - 49.22，p = 0.010）、癫痫持续状态持续时间≥24小时（比值比4.82，95%可信区间1.04 - 22.37，p = 0.044）以及神经影像学上的皮质或海马异常（比值比9.49，95%可信区间1.90 - 47.50，p = 0.006）是CSE后DRE发展的独立预测因素。这3个变量的组合产生的ROC曲线下面积为0.77（0.65 - 0.89）。
癫痫病史、较长的癫痫持续状态持续时间以及神经影像学上的皮质或海马异常是CSE后DRE发展的早期预测因素。需要进一步研究评估更积极的治疗是否会降低这些高危患者发生DRE的可能性。
