Jindal Malaika, Neligan Aidan, Rajakulendran Sanjeev
UCL Queen Square Institute of Neurology, London, United Kingdom.
UCL Queen Square Institute of Neurology, London, United Kingdom; Homerton University Hospital NHS Foundation Trust, London, United Kingdom.
Seizure. 2023 Oct;111:98-102. doi: 10.1016/j.seizure.2023.07.022. Epub 2023 Jul 28.
We investigated the management and outcome of early and established status epilepticus including timing, dosing and selection of benzodiazepines along with the timing and efficacy of second line treatments.
Retrospective single tertiary centre observational cohort study to identify all cases of SE between January 2019 and February 2022.
252 cases were identified. Seizures terminated spontaneously in 136 (54%) cases. 116 (46%) were given benzodiazepines, of which 29 (25%) were given at least one benzodiazepine by family/carers, and 72 (62.1%) received benzodiazepines by ambulance services. Benzodiazepines terminated seizures in 83 (71.6%) cases. The commonest benzodiazepine used was buccal midazolam (35.5%). Median time to first benzodiazepine was 14.5 (6-27) minutes. There was a positive correlation between time to first benzodiazepine and time to seizure cessation, progression to second- and third-line treatment, and respiratory complications (p<0.05). 73 (62.9%) cases received a correct benzodiazepine dose. Benzodiazepine underdosing was associated with longer seizure duration (p<0.05). 33 (28.4%) cases progressed to second-line treatment where mean time to treatment was 59.4 min (±32.3 min). The commonest second-line treatment was Levetiracetam (53.8%), followed by Phenytoin (43.6%) with SE termination in 57.5% cases. 14 (12.1%) cases progressed to third-line treatment; mean time to treatment was 60.6 min (±22.24 min). Respiratory complications occurred in 17 (6.75%) cases; none due to benzodiazepines. There were two deaths in refractory SE.
Early administration of benzodiazepines and optimal dosing is associated with a higher rate of SE termination. Levetiracetam was the most commonly used second line treatment.
我们研究了早期和确诊的癫痫持续状态的管理及结果，包括苯二氮䓬类药物的给药时间、剂量和选择，以及二线治疗的时间和疗效。
进行回顾性单中心观察队列研究，以确定2019年1月至2022年2月期间所有癫痫持续状态病例。
共识别出252例病例。136例（54%）癫痫发作自行终止。116例（46%）给予了苯二氮䓬类药物，其中29例（25%）由家属/护理人员给予至少一种苯二氮䓬类药物，72例（62.1%）由急救服务人员给予苯二氮䓬类药物。苯二氮䓬类药物使83例（71.6%）的癫痫发作终止。最常用的苯二氮䓬类药物是口腔咪达唑仑（35.5%）。首次给予苯二氮䓬类药物的中位时间为14.5（6 - 27）分钟。首次给予苯二氮䓬类药物的时间与癫痫发作停止时间、进展至二线和三线治疗以及呼吸并发症之间存在正相关（p<0.05）。73例（62.9%）病例给予了正确剂量的苯二氮䓬类药物。苯二氮䓬类药物剂量不足与癫痫发作持续时间延长相关（p<0.05）。33例（28.4%）病例进展至二线治疗，二线治疗的平均时间为59.4分钟（±32.3分钟）。最常用的二线治疗药物是左乙拉西坦（53.8%），其次是苯妥英（43.6%），57.5%的病例癫痫持续状态终止。14例（12.1%）病例进展至三线治疗；三线治疗的平均时间为60.6分钟（±22.24分钟）。17例（6.75%）病例出现呼吸并发症；均非由苯二氮䓬类药物引起。难治性癫痫持续状态中有2例死亡。
早期给予苯二氮䓬类药物和最佳剂量与更高的癫痫持续状态终止率相关。左乙拉西坦是最常用的二线治疗药物。
