Orlandi Niccolò, Giovannini Giada, Cioclu Maria Cristina, Biagioli Niccolò, Madrassi Laura, Vaudano Anna Elisabetta, Pugnaghi Matteo, Lattanzi Simona, Meletti Stefano
Neurology Unit, Ospedale Civile, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy.
Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy.
Eur J Neurol. 2024 Apr;31(4):e16177. doi: 10.1111/ene.16177. Epub 2024 Jan 23.
Long-term consequences after status epilepticus (SE) represent an unsettled issue. We investigated the incidence of remote unprovoked seizures (RS) and drug-resistant epilepsy (DRE) in a cohort of first-ever SE survivors.
A retrospective, observational, and monocentric study was conducted on adult patients (age ≥ 14 years) with first SE who were consecutively admitted to the Modena Academic Hospital, Italy (September 2013-March 2022). Kaplan-Meier survival analyses were used to calculate the probability of seizure freedom following the index event, whereas Cox proportional hazard regression models were used to identify outcome predictors.
A total of 279 patients were included, 57 of whom (20.4%) developed RS (mean follow-up = 32.4 months). Cumulative probability of seizure freedom was 85%, 78%, and 68% respectively at 12 months, 2 years, and 5 years. In 45 of 57 patients (81%), the first relapse occurred within 2 years after SE. The risk of RS was higher in the case of structural brain damage (hazard ratio [HR] = 2.1, 95% confidence interval [CI] = 1.06-4.01), progressive symptomatic etiology (HR = 2.7, 95% CI = 1.44-5.16), and occurrence of nonconvulsive evolution in the semiological sequence of SE (HR = 2.9, 95% CI = 1.37-6.37). Eighteen of 57 patients (32%) developed DRE; the risk was higher in the case of super-refractory (p = 0.006) and non-convulsive SE evolution (p = 0.008).
The overall risk of RS was moderate, temporally confined within 2 years after the index event, and driven by specific etiologies and SE semiology. Treatment super-refractoriness and non-convulsive SE evolution were associated with DRE development.
癫痫持续状态（SE）后的长期后果仍是一个未解决的问题。我们调查了首次发生SE的幸存者队列中远期无诱因发作（RS）和药物难治性癫痫（DRE）的发生率。
对意大利摩德纳学术医院（2013年9月至2022年3月）连续收治的首次发生SE的成年患者（年龄≥14岁）进行了一项回顾性、观察性单中心研究。采用Kaplan-Meier生存分析计算索引事件后无癫痫发作的概率，而Cox比例风险回归模型用于识别结局预测因素。
共纳入279例患者，其中57例（20.4%）发生RS（平均随访32.4个月）。在第12个月、2年和5年时，无癫痫发作的累积概率分别为85%、78%和68%。在57例患者中的45例（81%）中，首次复发发生在SE后的2年内。结构性脑损伤（风险比[HR]=2.1，95%置信区间[CI]=1.06-4.01）、进行性症状性病因（HR=2.7，95%CI=1.44-5.16）以及SE症状学序列中出现非惊厥性演变（HR=2.9，95%CI=1.37-6.37）的情况下，RS风险更高。57例患者中有18例（32%）发生DRE；在超级难治性（p=0.006）和非惊厥性SE演变（p=0.008）的情况下，风险更高。
RS的总体风险为中度，时间上局限于索引事件后的2年内，且由特定病因和SE症状学驱动。治疗超级难治性和非惊厥性SE演变与DRE的发生相关。
