Oliveros Juste A
Servicio de Neurología, Hospital Miguel Servet, Zaragoza.
Neurologia. 1997 Dec;12 Suppl 6:74-81.
Status epilepticus (SE), an special epileptic syndrome, is a frequent neurological emergency (50/100,000) and a critical condition (mean mortality 22%, in 3% of pediatric patients and 38% in the elderly). Accepting its widest concept, it appears without history of epilepsy in 58%. Neuronal damage, mainly hypocampal, has been experimentally demonstrated in convulsive and nonconvulsive SE. We attempt to demonstrate that the most important prognostic factors are: age, more related to morbidity in children and in mortality in the elderly; etiology, determining the evolution in most cases, but not always: in the same etiological group, the coincidence of SE can increase threefold the mortality; the seizure type, especially the convulsive SE; patients with previous epilepsy have a better outcome; the epileptic syndrome, rather determinant of incidence and outcome of the SE in the childhood; the length of SE, but in the cases of outcome directly depending on the etiology; the evolutive phase in which treatment is started; the complications, mainly respiratory; the global therapeutical strategy and the adequate use of drugs, related to order, dosage and timing, are determinant of morbidity and mortality.
癫痫持续状态(SE)是一种特殊的癫痫综合征,是常见的神经科急症(发病率为50/100,000),也是一种危急病症(平均死亡率为22%,在儿科患者中为3%,在老年患者中为38%)。从最宽泛的概念来看,58%的癫痫持续状态患者既往无癫痫病史。在惊厥性和非惊厥性癫痫持续状态中,均已通过实验证实存在神经元损伤,主要是海马区的损伤。我们试图证明,最重要的预后因素包括:年龄,在儿童中更多与发病率相关,在老年人中与死亡率相关;病因,在大多数情况下决定病情发展,但并非总是如此:在同一病因组中,癫痫持续状态的并发可使死亡率增加两倍;发作类型,尤其是惊厥性癫痫持续状态;既往有癫痫病史的患者预后较好;癫痫综合征,在很大程度上决定儿童癫痫持续状态的发病率和预后;癫痫持续状态的持续时间,但在预后直接取决于病因的情况下除外;开始治疗时的疾病进展阶段;并发症,主要是呼吸系统并发症;整体治疗策略以及药物的合理使用,与用药顺序、剂量和时机有关,是发病率和死亡率的决定因素。