Westmead Comprehensive Epilepsy Centre, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.
Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
Epilepsia. 2024 Jun;65(6):1605-1619. doi: 10.1111/epi.17975. Epub 2024 Apr 18.
Determination of the real-world performance of a health care system in the treatment of status epilepticus (SE).
Prospective, multicenter population-based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30-day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously.
A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self-terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre-hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups.
When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self-limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care.
确定医疗保健系统在治疗癫痫持续状态（SE）方面的实际表现。
这是一项在新西兰奥克兰进行的为期 1 年的前瞻性、多中心基于人群的 SE 研究，数据记录在 EpiNet 数据库中。重点关注治疗模式以及 SE 持续时间和 30 天死亡率的决定因素。该队列的发病率、病因、种族差异和发作特征此前已发表。
本治疗队列共纳入 365 例患者；326 例（89.3%）因 SE 被送往医院，而 39 例（10.7%）在因其他原因住院期间发生 SE。总体而言，190 例（52.1%）有已知的癫痫病史，254 例（70.0%）表现为伴有明显运动活动的 SE。平均癫痫持续状态严重程度评分（STESS）为 2.15，所有患者的 SE 持续时间平均为 44 分钟。84 例（22.7%）患者在没有任何治疗的情况下 SE 自行终止。在院前环境中尽早给予适当剂量的苯二氮䓬类药物是 SE 持续时间的主要决定因素。单因素分析表明，死亡率在年龄较大的患者、SE 持续时间较长的患者、STESS 较高的患者和在医院发生 SE 的患者中显著较高，但这些在多因素分析中并不显著。不同种族群体的医疗保健系统在 SE 治疗方面没有差异。
当 SE 定义为连续 10 分钟的发作时，总体死亡率低于预期，许多患者的发作呈自限性，无需治疗。尽管不同种族群体的 SE 发病率存在差异，但治疗或结果没有差异。这一发现强调了旨在提供全民医疗保健的医疗保健系统的好处。
