Drislane F W, Schomer D L
Department of Neurology, Beth Israel Hospital, Boston, MA 02215.
Epilepsy Res. 1994 Oct;19(2):111-21. doi: 10.1016/0920-1211(94)90021-3.
We reviewed clinical features of 48 patients without prior epilepsy who had generalized electrographic status epilepticus (ESE) identified from EEG readings. Clinical status epilepticus (SE) had occurred in 40%, but most were thought to have stopped seizing. Overall, ESE was unsuspected in 81% of patients. Many types of seizures were present before the EEG, but clinical seizures recurred in only 17 patients after diagnosis, and 18 patients (38%) never had clinical evidence of seizures. Most patients (60%) were comatose. The cause of ESE often remained uncertain though many patients had serious medical illnesses. Eighty-eight percent died, and a poor outcome was predicted by coma at the time of diagnosis (29 of 29), anoxia (15 of 15), an invariantly discharging, low-voltage background EEG (15 of 16), and refractory electrographic or clinical seizures (29 of 31). Seizure type did not predict outcome, and mortality was as high for patients without clinical evidence of seizures (89%) as for the series as a whole. ESE is often unanticipated and signifies neurologic disease with a prognosis worse than convulsive SE or the typical nonconvulsive SE; the absence of clinical seizures confers no advantage.
我们回顾了48例既往无癫痫病史、经脑电图（EEG）读数确诊为全面性癫痫性电持续状态（ESE）患者的临床特征。40%的患者曾发生临床癫痫持续状态（SE），但多数患者被认为已停止发作。总体而言，81%的患者未被怀疑患有ESE。EEG检查前存在多种类型的发作，但诊断后仅有17例患者再次出现临床发作，18例患者（38%）从未有过临床发作的证据。多数患者（60%）处于昏迷状态。尽管许多患者患有严重的内科疾病，但ESE的病因往往仍不明确。88%的患者死亡，诊断时昏迷（29例中的29例）、缺氧（15例中的15例）、脑电图背景持续低电压放电（16例中的15例）以及难治性癫痫性电发作或临床发作（31例中的29例）预示着预后不良。发作类型不能预测预后，无临床发作证据患者的死亡率（89%）与整个系列患者的死亡率一样高。ESE常常难以预料，提示神经系统疾病，其预后比惊厥性SE或典型的非惊厥性SE更差；无临床发作并无优势。
