Gajate-García V, Gutiérrez-Viedma Á, Romeral-Jiménez M, Serrano-García I, Parejo-Carbonell B, Montalvo-Moraleda T, Valls-Carbó A, García-Morales I
Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
Servicio de Neurología, Hospital Fundación Jiménez Díaz, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD), Madrid, España.
Neurologia (Engl Ed). 2020 Jun 18. doi: 10.1016/j.nrl.2020.02.007.
Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department.
We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017.
We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P<.001) and with history of refractory epilepsy (P=.002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P=.049) and status epilepticus (P=.018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was .45 (diagnosis was modified in 20% of patients).
Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.
癫痫发作是急诊入院的常见原因，需要早期、准确的诊断和治疗。本研究的目的是描述我院急诊科收治的一系列癫痫发作患者的临床和预后特征。
我们对2017年2月至8月期间我院急诊科收治并由值班神经科服务团队诊治的所有癫痫发作患者进行了一项回顾性观察研究。
我们纳入了153例患者，占神经科急诊入院患者总数的9.9%。中位年龄为58岁，52.3%的患者为女性，51%有癫痫病史。82.4%的病例发作起始为局灶性，最常见的病因是脑血管疾病（24.2%）。12例患者（7.8%）发生癫痫持续状态，这与ADAN量表得分较高（P<0.001）以及难治性癫痫病史相关（P = 0.002）。住院死亡率为3.7%，住院死亡与年龄较大（P = 0.049）和癫痫持续状态（P = 0.018）相关。80%无癫痫病史的患者在急诊科被诊断为癫痫；均开始接受治疗。急诊科癫痫诊断与癫痫专科随访一年后的诊断相比，kappa系数为0.45（20%的患者诊断被修正）。
癫痫发作是常见的神经科急症，存在潜在并发症，发病率和死亡率相当高。对于无已知癫痫病史的患者，可在急诊科进行诊断，但建议在癫痫专科进行随访。
