Department of Neurology, NIMHANS, Bengaluru, India.
Department of Neurochemistry, NIMHANS, Bengaluru, India.
Epilepsy Res. 2024 Oct;206:107442. doi: 10.1016/j.eplepsyres.2024.107442. Epub 2024 Aug 22.
New onset status epilepticus (NOSE), a subtype of status epilepticus, is a neurological emergency associated with significant morbidity and mortality. This study aimed to analyze the phenotypic spectrum and outcomes of patients presenting with NOSE.
This prospective and retrospective descriptive study included patients presenting with NOSE over a 10-year period. Data collected included patient demographics, phenotypic characteristics of SE and its etiology, Status Epilepticus Severity Score (STESS), SE classification Axis-II, and Modified Rankin Scale (mRS) scores at admission and discharge. Functional outcomes and seizure status were assessed at least 6 months post-discharge. Prognostic factors for mortality and the development of epilepsy were also analyzed.
A total of 208 patients were included, with a mean age of 41.97 ± 21.66 years, and a male predominance (57.1 %). Focal to bilateral tonic-clonic seizures were observed in 47.5 % of patients. The etiology was acute symptomatic in 35.57 % and remote symptomatic in 24 %. The median hospital stay was 4 days (range: 2.25-10.75 days). The mortality rate was 26.5 %, and 23 % of patients developed epilepsy with a median follow-up of 9 months. Higher age (≥ 50 years), elevated STESS, ICU admission, use of anesthetic agents, refractory status epilepticus (RSE), and new-onset refractory status epilepticus (NORSE) were significant risk factors for mortality (p<0.05). The development of epilepsy was associated with a higher number of antiseizure medications (ASM) at discharge, ICU admission, use of anesthetic agents, RSE, and NORSE (p<0.05).
NOSE is a neurological emergency with a variable etiology and significant long-term consequences. Approximately one-fourth of patients presenting with NOSE died, and another quarter developed epilepsy during a median follow-up of 9 months. Identifying and addressing the predictors of mortality and epilepsy development following NOSE may improve long-term outcomes.
新发全面性癫痫持续状态（NOSE）是癫痫持续状态的一种亚型，是一种与高发病率和死亡率相关的神经系统急症。本研究旨在分析伴有 NOSE 的患者的表型谱和结局。
本前瞻性和回顾性描述性研究纳入了 10 年间出现 NOSE 的患者。收集的数据包括患者人口统计学特征、癫痫持续状态的表型特征及其病因、癫痫持续状态严重程度评分（STESS）、癫痫持续状态分类轴-II 和入院及出院时的改良 Rankin 量表（mRS）评分。出院后至少 6 个月评估功能结局和癫痫发作情况。还分析了死亡率和癫痫发生的预后因素。
共纳入 208 例患者，平均年龄为 41.97±21.66 岁，男性居多（57.1%）。47.5%的患者出现局灶性到双侧强直-阵挛性发作。病因急性症状性占 35.57%，远隔症状性占 24%。中位住院时间为 4 天（范围：2.25-10.75 天）。死亡率为 26.5%，23%的患者在中位随访 9 个月后发生癫痫。较高的年龄（≥50 岁）、较高的 STESS、入住 ICU、使用麻醉剂、难治性癫痫持续状态（RSE）和新发难治性癫痫持续状态（NORSE）是死亡的显著危险因素（p<0.05）。癫痫的发生与出院时抗癫痫药物（ASM）数量增加、入住 ICU、使用麻醉剂、RSE 和 NORSE 相关（p<0.05）。
NOSE 是一种具有多种病因和显著长期后果的神经系统急症。大约四分之一出现 NOSE 的患者死亡，另有四分之一在中位随访 9 个月时发生癫痫。确定并处理 NOSE 后死亡率和癫痫发生的预测因素可能会改善长期结局。
