Division of Pediatric Critical Care, Department of Pediatrics at Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Pediatric Critical Care, Department of Pediatrics at Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Taiwan.
Biomed J. 2020 Jun;43(3):277-284. doi: 10.1016/j.bj.2020.04.004. Epub 2020 Apr 21.
To compare the clinical characteristics and outcomes of pediatric patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) who received therapeutic hypothermia (TH) plus anticonvulsants or anticonvulsants alone.
Two-medical referral centers, retrospective cohort study. Pediatric Intensive Care Unit (PICU) at Taoyuan Chang Gung Children's hospital and Kaohsiung Chang Gung Memorial Hospital. We reviewed the medical records of 23 patients with RSE/SRSE who were admitted to PICU from January 2014 to December 2017. Of these, 11 patients received TH (TH group) and 12 patients did not (control group).
The selective endpoints were RSE/SRSE duration, length of PICU stay, and Glasgow Outcome Scale (GOS) score. We applied TH using the Artic Sun® temperature management system (target temperature, 34-35 °C; duration, 48-72 h). Of the 11 patients who received TH, 7 had febrile infection-related epilepsy syndrome (FIRSE), one had Dravet syndrome, and three had traumatic brain injury. The TH group had significantly shortern seizure durations than did the control group (hrs; median (IQR) 24(40) vs. 96(90), p < 0.05). Two patients in the TH group died of pulmonary embolism and extreme brain edema. The length of PICU stay was similar between the groups (days; median (IQR) 30(42) v.s 30.5(30.25)). The TH group had significantly better long-term outcomes than did the control group (GOS score, median (IQR) 4(2) v.s 3 (0.75), p = 0.01∗). The TH group had a significantly lower incidence of later chronic refractory epilepsy than did the control group (TH v.s non-TH, 5/11 (45%) v.s. 12/12(100%), p < 0.01).
TH effectively reduced the seizure burden in patients with RSE/SRSE. Our findings support that for patients with RSE/SRSE, TH shortens the seizure duration, ultimately reducing the occurrence of post-status epilepticus epilepsy and improving patients' long-term survival.
比较接受治疗性低温（TH）加抗惊厥药物与单独使用抗惊厥药物治疗的难治性癫痫持续状态（RSE）和超难治性癫痫持续状态（SRSE）儿科患者的临床特征和结局。
两家医疗转诊中心，回顾性队列研究。桃园长庚儿童医院和高雄长庚纪念医院的儿科重症监护病房（PICU）。我们回顾了 2014 年 1 月至 2017 年 12 月期间收治于 PICU 的 23 例 RSE/SRSE 患儿的病历。其中 11 例接受 TH（TH 组），12 例未接受（对照组）。
选择终点为 RSE/SRSE 持续时间、PICU 住院时间和格拉斯哥预后量表（GOS）评分。我们使用 Artic Sun®温度管理系统（目标温度 34-35°C；持续时间 48-72 小时）进行 TH。接受 TH 的 11 例患者中，7 例为热性感染相关性癫痫综合征（FIRSE），1 例为 Dravet 综合征，3 例为创伤性脑损伤。TH 组的癫痫发作时间明显短于对照组（小时；中位数（IQR）24（40）vs. 96（90），p<0.05）。TH 组有 2 例患者死于肺栓塞和严重脑水肿。两组 PICU 住院时间相似（天；中位数（IQR）30（42）v.s 30.5（30.25））。TH 组的长期预后明显优于对照组（GOS 评分，中位数（IQR）4（2）v.s 3（0.75），p=0.01*）。TH 组迟发性慢性难治性癫痫的发生率明显低于对照组（TH 组与非 TH 组，5/11（45%）vs. 12/12（100%），p<0.01）。
TH 可有效降低 RSE/SRSE 患者的癫痫发作负荷。我们的研究结果支持对于 RSE/SRSE 患者，TH 可缩短癫痫发作时间，最终减少癫痫后状态的发生，提高患者的长期生存率。
