From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
Neurology. 2023 Apr 25;100(17):e1763-e1775. doi: 10.1212/WNL.0000000000206838. Epub 2023 Mar 6.
To assess the frequency of status epilepticus (SE) among seizing critically ill adult patients and to determine clinical differences between patients with isolated seizures and patients with SE in the intensive care unit (ICU).
From 2015 to 2020, all consecutive adult ICU patients at a Swiss tertiary care center with isolated seizures or SE as reported by intensivists and/or consulting neurologists were identified by screening of all digital medical, ICU, and EEG records. Patients aged <18 years and patients with myoclonus due to hypoxic-ischemic encephalopathy but without seizures on EEG were excluded. The frequency of isolated seizures, SE, and clinical characteristics at seizure onset associated with SE were the primary outcomes. Uni- and multivariable logistic regression was performed to identify associations with the emergence of SE.
Among 404 patients with seizures, 51% had SE. Compared with patients with isolated seizures, patients with SE had a lower median Charlson Comorbidity Index (CCI) (3 vs 5, < 0.001), fewer fatal etiologies (43.6% vs 80.5%, < 0.001), higher median Glasgow coma scores (7 vs 5, < 0.001), fever more frequently (27.5% vs 7.5%, < 0.001), shorter median ICU and hospital stay (ICU: 4 vs 5 days, = 0.039; hospital stay: 13 vs 15 days, = 0.045), and recovered to premorbid function more often (36.8% vs 17%, < 0.001). Multivariable analyses revealed decreased odds ratios (ORs) for SE with increasing CCI (OR 0.91, 95% CI 0.83-0.99), fatal etiology (OR 0.15, 95% CI 0.08-0.29), and epilepsy (OR 0.32, 95% CI 0.16-0.63). Systemic inflammation was an additional association with SE after excluding patients with seizures as the reason for ICU admission (OR 1.01, 95% CI 1.00-1.01; OR 7.35, 95% CI 2.84-19.0). Although fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy.
Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention.
评估危重症成年患者癫痫持续状态（SE）的发生率，并确定重症监护病房（ICU）中单纯性发作和 SE 患者之间的临床差异。
从 2015 年至 2020 年，通过筛选所有数字医疗、ICU 和 EEG 记录，确定了瑞士一家三级护理中心的所有连续成年 ICU 患者中由重症监护医生和/或咨询神经科医生报告的单纯性发作或 SE。排除年龄<18 岁的患者和因缺氧缺血性脑病导致肌阵挛但 EEG 无发作的患者。主要结局为单纯性发作、SE 以及与 SE 相关的发作起始时的临床特征。采用单变量和多变量逻辑回归来确定与 SE 发生相关的因素。
在 404 例癫痫发作患者中，51%的患者出现 SE。与单纯性发作患者相比，SE 患者的中位 Charlson 合并症指数（CCI）较低（3 与 5，<0.001），致命病因较少（43.6%与 80.5%，<0.001），Glasgow 昏迷评分较高（7 与 5，<0.001），发热更常见（27.5%与 7.5%，<0.001），ICU 和住院时间较短（ICU：4 天与 5 天，=0.039；住院：13 天与 15 天，=0.045），且恢复到发病前功能的比例更高（36.8%与 17%，<0.001）。多变量分析显示，CCI 增加（OR 0.91，95%CI 0.83-0.99）、致命病因（OR 0.15，95%CI 0.08-0.29）和癫痫（OR 0.32，95%CI 0.16-0.63）的 SE 比值降低。在排除 ICU 入住原因是癫痫发作的患者后，全身性炎症也是 SE 的另一个关联因素（OR 1.01，95%CI 1.00-1.01；OR 7.35，95%CI 2.84-19.0）。尽管致命病因和 CCI 增加与 SE 发生的低几率相关，但在排除麻醉患者和缺氧缺血性脑病后，CCI 增加、致命病因和癫痫仍然与 SE 相关，除了癫痫患者之外，炎症在所有亚组中仍然与 SE 相关。
在所有 ICU 癫痫发作患者中，SE 频繁出现，每两个患者中就有一个。除了 CCI 较高、致命病因和癫痫发作时 SE 发生的几率较低这一意外发现外，炎症与非癫痫危重症患者的 SE 相关，这代表了一个潜在的治疗靶点，值得进一步关注。
