Rao Shishir Keekana, Mahulikar Advait, Ibrahim Mohammad, Shah Aashit, Seraji-Bozorgzad Navid, Mohamed Wazim
Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI USA.
Epileptic Disord. 2018 Aug 1;20(4):265-269. doi: 10.1684/epd.2018.0987.
Status epilepticus (SE) is defined as ongoing seizures lasting longer than five minutes or multiple seizures without recovery. Benzodiazepines (BZDs) are first-line agents for the management of SE. Our objective was to evaluate BZD dosing in SE patients and its effects on clinical/electrographic outcomes. A retrospective analysis was conducted from a prospective database of SE patients admitted to a university-based neurocritical care unit. The initial presentation and progression to refractory SE (RSE) and non-convulsive SE (NCSE) with coma was evaluated. Outcome measures included length of stay (LOS), rates of intubation, ventilator-dependent days, and Glasgow outcome scale (GOS). The lorazepam equivalent (LE) dosage of BZDs administered was calculated and we analysed variations in progression if 4 mg or more of LE (adequate BZDs) was administered. Among 100 patients, the median dose of LE was 3 mg (IQR: 2-5 mg). Only 31% of patients received adequate BZDs. Only 18.9% of patients with NCSE without coma received adequate BZDs (p=0.04). Among patients progressing to RSE, 75.4% had not received adequate BZDs (p=0.04) and among patients developing NCSE with coma, 80.6% did not receive adequate BZDs (p=0.07). Escalating doses of BZDs were associated with a decrease in cumulative incidences of RSE (correlation coefficient r=-0.6; p=0.04) and NCSE with coma (correlation coefficient r=-0.7; p=0.003). Outcome measures were not influenced by BZD dosing. The majority of our patients were not adequately dosed with BZDs. Inadequate BZD dosing progressed to RSE and had a tendency to lead to NCSE with coma. Our study demonstrates the need to develop a hospital-wide protocol to guide first responders in the management of SE.
癫痫持续状态（SE）被定义为持续超过五分钟的持续性癫痫发作或多次发作且无恢复。苯二氮䓬类药物（BZDs）是治疗SE的一线药物。我们的目的是评估SE患者中BZD的给药剂量及其对临床/脑电图结果的影响。我们对一所大学神经重症监护病房收治的SE患者的前瞻性数据库进行了回顾性分析。评估了初始表现以及进展为难治性SE（RSE）和伴有昏迷的非惊厥性SE（NCSE）的情况。结果指标包括住院时间（LOS）、插管率、呼吸机依赖天数和格拉斯哥预后量表（GOS）。计算了所给予的BZDs的劳拉西泮等效剂量（LE），并且我们分析了如果给予4毫克或更多的LE（足够的BZDs）时进展情况的差异。在100例患者中，LE的中位剂量为3毫克（四分位间距：2 - 5毫克）。只有31%的患者接受了足够的BZDs。没有昏迷的NCSE患者中只有18.9%接受了足够的BZDs（p = 0.04）。在进展为RSE的患者中，75.4%未接受足够的BZDs（p = 0.04），在发生伴有昏迷的NCSE的患者中，80.6%未接受足够的BZDs（p = 0.07）。BZDs剂量的增加与RSE（相关系数r = -0.6；p = 0.04）和伴有昏迷的NCSE（相关系数r = -0.7；p = 0.003）的累积发生率降低相关。结果指标不受BZD给药剂量的影响。我们的大多数患者未接受足够剂量的BZDs。BZD给药不足进展为RSE，并且有导致伴有昏迷的NCSE的趋势。我们的研究表明需要制定一项全院范围的方案来指导急救人员对SE的管理。
