Child Neurology and Psychiatry Unit, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
Child Neurology and Psychiatry Unit, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
Seizure. 2020 May;78:127-133. doi: 10.1016/j.seizure.2020.03.019. Epub 2020 Apr 17.
The aim of this study is to describe demographic data, semiology and etiology in a pediatric population with status epilepticus (SE) and refractory SE (RSE).
We retrospectively reviewed patients with the following inclusion criteria: i) age between two months and eighteen years; ii) SE diagnosis; iii) admission from January 2001 to December 2016; iv) available clinical data.
We enrolled 124 patients. Mean and median age was 4.6 ± 4.2 years and 3.3 [1.2-7.5] years respectively. SE had a "de novo" onset in 66.9%. Focal convulsive-SE was the most common semiology (50.8%) whilst generalised (32.3%) and nonconvulsive-SE (NCSE) (16.9%) were less represented. Some etiologies showed a different age distribution: febrile in youngest age (p = 0.002, phi 0.3) and idiopathic-cryptogenic in older children (p = 0.016, phi 0.2). A statistical significance correlation was detected between semiology and etiology (p < 0.001, Cramer's V 0.4), chemotherapy and NCSE (n = 6/21 vs 3/103, p < 0.001) as well as PRES and NCSE (n = 7/21 vs 5/103, p < 0.001). Only 17.7% had a RSE. No correlation was found in demographic and clinical data, but NCSE, acute and idiopathic-cryptogenic etiologies were more frequently associated to RSE. Encephalitis was the most common diagnosis in acute etiologies whereas unknown epilepsy in idiopathic-cryptogenic group.
Most of our findings were previously described however we found a significant role of non-antiepileptic treatments (chemotherapy-dialysis) and comorbidity (PRES) determining acute etiology and NCSE. Acute (mostly encephalitis), idiopathic-cryptogenic (mainly unknown-epilepsy) and NCSE were frequently detected in RSE. In the above mentioned conditions a high level of suspicion was recommended.
本研究旨在描述儿科癫痫持续状态（SE）和难治性 SE（RSE）患者的人口统计学数据、症状学和病因学。
我们回顾性分析了 2001 年 1 月至 2016 年 12 月期间符合以下纳入标准的患者：i）年龄在 2 个月至 18 岁之间；ii）SE 诊断；iii）住院治疗；iv）有临床资料。
我们共纳入了 124 例患者。平均和中位数年龄分别为 4.6±4.2 岁和 3.3[1.2-7.5]岁。66.9%的患者 SE 为“新发”。最常见的 SE 症状学表现为局灶性惊厥性 SE（50.8%），而全身性（32.3%）和非惊厥性 SE（NCSE）（16.9%）则较少见。某些病因的发病年龄分布不同：热性惊厥在年龄较小的患者中更常见（p=0.002，phi 0.3），而特发性-隐源性在年龄较大的儿童中更常见（p=0.016，phi 0.2）。我们还发现症状学和病因学之间存在统计学意义的相关性（p<0.001，Cramer's V 0.4），化疗与 NCSE（n=6/21 与 n=3/103，p<0.001）以及 PRES 与 NCSE（n=7/21 与 n=5/103，p<0.001）之间也存在相关性。只有 17.7%的患者为 RSE。我们未发现人口统计学和临床数据之间存在相关性，但 NCSE、急性和特发性-隐源性病因更常与 RSE 相关。急性病因中脑炎最常见，而特发性-隐源性病因中未知癫痫最常见。
我们的大多数发现与之前的报道一致，但我们发现非抗癫痫治疗（化疗-透析）和合并症（PRES）在确定急性病因和 NCSE 方面具有重要作用。急性（主要是脑炎）、特发性-隐源性（主要是未知癫痫）和 NCSE 在 RSE 中经常出现。在上述情况下，建议高度怀疑。
