新起的超难治性癫痫持续状态：病例系列。

New-onset super refractory status epilepticus: A case-series.

机构信息

Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.

Neurosciences Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Anaesthesia Neuroimaging Research Group, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

出版信息

Seizure. 2020 Feb;75:174-184. doi: 10.1016/j.seizure.2019.10.005. Epub 2019 Nov 9.

DOI:10.1016/j.seizure.2019.10.005

PMID:31757748

Abstract

INTRODUCTION

Literature on New-Onset Refractory Status Epilepticus (NORSE) is scarce and management is guided mainly by retrospective reports, short case series or expert opinions. We aimed to add to the pool of the available data by retrospectively reviewing seven cases of NORSE cases admitted to our hospital over the last five years between January 2014 and March 2019.

METHODS

Fully anonymised data from medical charts, EEG reports, imaging reports, laboratory test results, types of antiepileptic medications, intravenous anaesthetic therapy, and immune therapies received was collected, along with response to treatment, length of hospital stay and outcome at discharge.

RESULTS

The mean age was 43.5 ± 23.8 years (range 18-75) and three patients were females. Prodromal symptoms consisted mainly of fever (4/7), headache (4/7) and self terminating seizures (7/7), before presenting with status epilepticus. Initial imaging findings were abnormal in 3/7 and CSF analysis in 3/7. All patients underwent intermittent EEG recordings, mainly for titration or tapering of the anaesthetic agents, with the initial goal of achieving burst suppression and cessation of electrographic seizures. Our index case spent the longest time in therapeutic burst suppression (102 days) and remained on thiopentone for 214 days. The mean duration of NICU stay was 88 ± 85.4 days (range 4-225 days) while the mean duration of hospital stay was 113.8 ± 111.2 days (range 17-292).

CONCLUSIONS

The management of patients with NORSE remains challenging, often requiring multiple intravenous anaesthetic treatments, leading to complicated and prolonged hospital and intensive care unit stays but good outcome remains possible.

摘要

介绍

关于新发性难治性癫痫持续状态（NORSE）的文献很少，其治疗主要基于回顾性报告、短篇病例系列或专家意见。我们旨在通过回顾性分析 2014 年 1 月至 2019 年 3 月期间在我院收治的 7 例 NORSE 病例的数据，来增加现有数据。

方法

收集病历、脑电图报告、影像学报告、实验室检查结果、抗癫痫药物类型、静脉麻醉治疗、免疫治疗等方面的完全匿名数据，以及治疗反应、住院时间和出院时的结果。

结果

平均年龄为 43.5±23.8 岁（18-75 岁），3 例为女性。前驱症状主要为发热（4/7）、头痛（4/7）和自限性发作（7/7），随后出现癫痫持续状态。初始影像学发现异常 3/7，CSF 分析异常 3/7。所有患者均行间歇性脑电图记录，主要用于麻醉剂的滴定或减量，初始目标为实现爆发抑制和停止电发作。我们的病例在治疗性爆发抑制中停留时间最长（102 天），且使用戊巴比妥的时间最长（214 天）。NICU 住院时间平均为 88±85.4 天（4-225 天），总住院时间平均为 113.8±111.2 天（17-292 天）。