Rivero Rodríguez Dannys, Fernandez Telmo, DiCapua Sacoto Daniela, Pernas Sanchez Yanelis, Morales-Casado María Isabel, Maldonado Nelson, Pluck Graham
Department of Neurology, Hospital Eugenio Espejo, Quito, Ecuador.
Department of Neurology, Hospital Universitario de Toledo, Toledo, Spain.
Neurocrit Care. 2025 Jan 28. doi: 10.1007/s12028-024-02201-0.
Super-refractory status epilepticus (SRSE) is an extremely serious neurological emergency. Risk factors and mechanisms involved in transition from refractory status epilepticus (RSE) to SRSE are insufficiently studied.
This was a multicenter retrospective cohort study of consecutive patients diagnosed and treated for RSE at two reference hospital over 5 years in Ecuador. A total of 140 patients were included. Potential demographic, clinical, and treatment variables that may predict progression from refractory to SRSE were analyzed.
Super-refractory status epilepticus was identified in 67/140 (48%) of patients. In univariate analyses, level of consciousness on hospital admission (Glasgow Coma Score < 12, odds ratio [OR] 2.9, p < 0.01), traumatic brain injury (OR 2.3, p = 0.05), acute etiology (OR 3.0, p = 0.04), higher Status Epilepticus Severity Score (STESS) (OR 1.7, p < 0.01), and new clinical or electrographic seizure within 6 h (OR 4.2, p < 0.01) of starting anesthetic infusion were important factors related to super-refractory disease. The best independents predictors of SRSE when the presence of other potential factors were considered for multivariate analysis. Two models were calculated to avoid interactions between similar variables. Glasgow Coma Score on hospital admission < 12 (OR 3.1 [95% confidence interval {CI} 1.16-8.29], p = 0.02) and new clinical or electroencephalography (EEG) seizure after first 6 h of starting anesthetic infusion (OR 3.1 [95% CI 1.36-7.09], p = 0.01) were associated with higher risk of progression to SRSE in model 1. In contrast, model 2 indicated that patients with STESS ≥ 3 points (OR 2.9 [95% CI 1.24-6.65], p = 0.01) and new clinical or EEG seizure after 6 h starting anesthetic infusion (OR 3.0 [95% CI 1.32-6.97], p = 0.01) were the factors independently related to super-refractory disease.
The rate of patients with RSE admitted to intensive care units developing SRSE was high. Low level of consciousness on admission, higher STESS scores, and patients who did not achieve total control of clinical or EEG seizure in the first 6 h of starting intravenous anesthetic infusion may be early indicators of SRSE.
超难治性癫痫持续状态（SRSE）是一种极其严重的神经急症。从难治性癫痫持续状态（RSE）转变为SRSE的危险因素和机制尚未得到充分研究。
这是一项多中心回顾性队列研究，对厄瓜多尔两家参考医院5年来连续诊断和治疗的RSE患者进行研究。共纳入140例患者。分析了可能预测从难治性进展为SRSE的潜在人口统计学、临床和治疗变量。
140例患者中有67例（48%）被确定为超难治性癫痫持续状态。在单因素分析中，入院时的意识水平（格拉斯哥昏迷评分＜12，比值比[OR]2.9，p＜0.01）、创伤性脑损伤（OR 2.3，p = 0.05）、急性病因（OR 3.0，p = 0.04）、较高的癫痫持续状态严重程度评分（STESS）（OR 1.7，p＜0.01）以及在开始麻醉输注后6小时内出现新的临床或脑电图发作（OR 4.2，p＜0.01）是与超难治性疾病相关的重要因素。在多因素分析中考虑其他潜在因素存在时，SRSE的最佳独立预测因素。计算了两个模型以避免相似变量之间的相互作用。入院时格拉斯哥昏迷评分＜12（OR 3.1[95%置信区间{CI}1.16 - 8.29]，p = 0.02）以及在开始麻醉输注的前6小时后出现新的临床或脑电图发作（OR 3.1[95%CI 1.36 - 7.09]，p = 0.01）在模型1中与进展为SRSE的较高风险相关。相比之下，模型2表明STESS≥3分的患者（OR 2.9[95%CI 1.24 - 6.65]，p = 0.01）以及在开始麻醉输注6小时后出现新的临床或脑电图发作（OR 3.0[95%CI 1.32 - 6.97]，p = 0.01）是与超难治性疾病独立相关的因素。
入住重症监护病房的RSE患者发展为SRSE的比例很高。入院时意识水平低、STESS评分较高以及在开始静脉麻醉输注的前6小时内未实现临床或脑电图发作完全控制的患者可能是SRSE的早期指标。
