Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.
Department of Neurology, E-Da Hospital, Kaohsiung, 82445, Taiwan.
Sci Rep. 2022 Jun 11;12(1):9670. doi: 10.1038/s41598-022-13726-9.
Super-refractory status epilepticus (SRSE) is a critical condition in which seizures persist despite anesthetic use for 24 h or longer. High mortality has been reported in patients with SRSE, but the cause of death remains unclear. We investigated the factors associated with mortality, including clinical characteristics, SE etiologies and severities, treatments, and responses in patients with SRSE in a 13-year tertiary hospital-based retrospective cohort study comparing these parameters between deceased and surviving patients. SRSE accounted for 14.2% of patients with status epilepticus, and 28.6% of SRSE patients died. Deceased patients were mostly young or middle-aged without known systemic diseases or epilepsy. All deceased patients experienced generalized convulsive status epilepticus and failure of anesthetic tapering-off, significantly higher than survivors. An increased number of second-line anesthetics besides midazolam was observed in the deceased (median, 3, interquartile range 2-3) compared to surviving (1, 1-1; p = 0.0006) patients with prolonged use durations (p = 0.047). For mortality, the cut-off number of second-line anesthetics was 1.5 (AUC = 0.906, p = 0.004). Deceased patients had significantly higher renal and cardiac complications and metabolic acidosis than survivors. In SRSE management, multi-anesthetic use should be carefully controlled to avoid systemic complications and mortality.
超难治性癫痫持续状态（SRSE）是一种危急状况，即使使用麻醉药物 24 小时或更长时间，癫痫仍持续发作。有报道称，SRSE 患者的死亡率较高，但死亡原因仍不清楚。我们在一项为期 13 年的三级医院回顾性队列研究中，调查了与死亡率相关的因素，包括临床特征、癫痫持续状态的病因和严重程度、治疗以及 SRSE 患者的反应，将这些参数在死亡患者和存活患者之间进行了比较。SRSE 占癫痫持续状态患者的 14.2%，其中 28.6%的 SRSE 患者死亡。死亡患者大多为无已知系统性疾病或癫痫的年轻或中年人群。所有死亡患者均经历全身性强直阵挛性癫痫持续状态和麻醉药物逐渐减量失败，显著高于存活患者。与存活患者（中位数 1，四分位距 1-1）相比，死亡患者使用二线麻醉药物（中位数 3，四分位距 2-3）的数量增加，且使用时间延长（p = 0.047）。对于死亡率，二线麻醉药物的截断值为 1.5（AUC = 0.906，p = 0.004）。死亡患者的肾脏和心脏并发症以及代谢性酸中毒发生率明显高于存活患者。在 SRSE 管理中，应谨慎控制多麻醉药物的使用，以避免出现全身并发症和死亡。
