Llauradó Arnau, Quintana Manuel, Ballvé Alejandro, Campos Daniel, Fonseca Elena, Abraira Laura, Toledo Manuel, Santamarina Estevo
Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain.
Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain.
J Neurol Sci. 2021 Apr 15;423:117368. doi: 10.1016/j.jns.2021.117368. Epub 2021 Feb 23.
To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode.
All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed.
Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001).
The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
研究癫痫持续状态（SE）中苯二氮䓬类药物（BZD）抵抗相关因素，重点关注其与发作病因的关系。
2011年2月至2019年4月，前瞻性收集我院中心所有年龄>16岁、接受BZD治疗的SE病例。登记内容包括人口统计学资料、SE类型和病因、BZD给药时间和持续时间以及结局。共分析了371次发作。
SE发作的中位年龄为61.3岁；最常见的病因是急性症状性（55.8%）。63.3%的患者出现明显运动症状的SE。BZD给药的中位时间为2小时。我们研究了两个时间变量之间的相关性：从SE发作到BZD给药的时间以及从BZD给药到SE缓解（反应）的时间；我们观察到，及时给药与有明显运动症状的患者（p = 0.017）、慢性结构性脑病变导致的SE（p = 0.004）以及有癫痫病史的患者（p = 0.013）的更快反应相关。在这些亚组（明显运动症状或慢性结构性病变）中，在最初4.5小时内给予BZD与BZD后SE持续时间较短高度相关（p < 0.001）。
发现及时给予BZD与随后SE持续时间之间的关系在一定程度上取决于发作的病因：慢性结构性病变患者和既往有癫痫病史的患者对BZD反应更快。症状学可能也有影响，因为明显运动症状的存在也显示出更快的反应。
