Lin Chih-Hsiang, Lu Yan-Ting, Ho Chen-Jui, Shih Fu-Yuan, Tsai Meng-Han
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Front Neurol. 2019 Feb 13;10:25. doi: 10.3389/fneur.2019.00025. eCollection 2019.
The prognosis of status epilepticus (SE) is highly related to the underlying etiology. Inflammation of the central nervous system (CNS), including infection and autoimmune encephalitis, is one of the treatable conditions causing SE. The initial presentation of infectious and autoimmune CNS disorders can be quite similar, which may be difficult to differentiate at the beginning. However, treatment for these entities can be quite different. In this study, we aim to identify the differences in clinical features among patients with infectious and autoimmune SE, which could help the clinicians to select initial investigation and ensuing therapies that may improve overall outcomes. This was a retrospective study that included 501 patients with SE within a period of 10.5-years. Patients with inflammatory etiology were collected and separated into infectious and autoimmune SE. The symptoms at onset, SE semiology, status epilepticus severity score, and END-IT score at admission, treatment for SE, and outcome (modified Rankin Scale) on discharge and last follow-up were recorded. Data on the first cerebrospinal fluid, electroencephalography, and magnetic resonance imaging were also collected. Forty-six (9.2%) of the 501 patients had SE with inflammatory etiology. Twenty-five (5%) patients were autoimmune SE and 21 (4.2%) were infectious SE. Patients with autoimmune SE have younger age and female predominance. As for clinical presentations, psychosis, non-convulsive SE, and super refractory SE were more common in patients with autoimmune SE. Nevertheless, the prognosis showed no difference between the two groups. The different initial clinical presentations and patient characteristics may provide some clues about the underlying etiology of SE. When inflammatory etiology is suspected in patients with SE, younger age, female sex, psychosis, non-convulsive SE, and super refractory SE are clinical features that suggest an autoimmune etiology.
癫痫持续状态（SE）的预后与潜在病因高度相关。中枢神经系统（CNS）炎症，包括感染和自身免疫性脑炎，是导致SE的可治疗病因之一。感染性和自身免疫性CNS疾病的初始表现可能非常相似，一开始可能难以区分。然而，这些疾病的治疗方法可能有很大不同。在本研究中，我们旨在确定感染性和自身免疫性SE患者临床特征的差异，这有助于临床医生选择初始检查和后续治疗，从而改善总体预后。这是一项回顾性研究，纳入了10.5年内的501例SE患者。收集了炎症性病因患者，并将其分为感染性和自身免疫性SE。记录了发病时的症状、SE症状学、入院时的癫痫持续状态严重程度评分和END-IT评分、SE治疗情况以及出院时和最后一次随访时的结局（改良Rankin量表）。还收集了首次脑脊液、脑电图和磁共振成像的数据。501例患者中有46例（9.2%）患有炎症性病因的SE。25例（5%）患者为自身免疫性SE，21例（4.2%）为感染性SE。自身免疫性SE患者年龄较轻，女性居多。至于临床表现，精神病、非惊厥性SE和超级难治性SE在自身免疫性SE患者中更为常见。然而，两组的预后没有差异。不同的初始临床表现和患者特征可能为SE的潜在病因提供一些线索。当怀疑SE患者有炎症性病因时，年龄较轻、女性、精神病、非惊厥性SE和超级难治性SE是提示自身免疫性病因的临床特征。
