DeLorenzo R J, Waterhouse E J, Towne A R, Boggs J G, Ko D, DeLorenzo G A, Brown A, Garnett L
Department of Neurology, Medical College of Virginia Commonwealth University, Richmond 23298-0599, USA.
Epilepsia. 1998 Aug;39(8):833-40. doi: 10.1111/j.1528-1157.1998.tb01177.x.
Convulsive status epilepticus (CSE) is a major medical and neurological emergency that is associated with significant morbidity and mortality. Despite this high morbidity and mortality, most acute care facilities in the United States cannot evaluate patients with EEG monitoring during or immediately after SE. The present study was initiated to determine whether control of CSE by standard treatment protocols was sufficient to terminate electrographic seizures.
One hundred sixty-four prospective patients were evaluated at the Medical College of Virginia/VCU Status Epilepticus Program. Continuous EEG monitoring was performed for a minimum of 24 h after clinical control of CSE. SE and seizure types were defined as described previously. A standardized data form entry system was compiled for each patient and used to evaluate the data collected.
After CSE was controlled, continuous EEG monitoring demonstrated that 52% of the patients had no after-SE ictal discharges (ASIDS) and manifested EEG patterns of generalized slowing, attenuation, periodic lateralizing epileptiform discharges (PLEDS), focal slowing, and/or burst suppression. The remaining 48% demonstrated persistent electrographic seizures. More than 14% of the patients manifested nonconvulsive SE (NCSE) predominantly of the complex partial NCSE seizure (CPS) type (2). These patients were comatose and showed no overt clinical signs of convulsive activity. Clinical detection of NCSE in these patients would not have been possible with routine neurological evaluations without use of EEG monitoring. The clinical presentation, mortality, morbidity, and demographic information on this population are reported.
Our results demonstrate that EEG monitoring after treatment of CSE is essential to recognition of persistent electrographic seizures and NCSE unresponsive to routine therapeutic management of CSE. These findings also suggest that EEG monitoring immediately after control of CSE is an important diagnostic test to guide treatment plans and to evaluate prognosis in the management of SE.
惊厥性癫痫持续状态（CSE）是一种主要的医学和神经科急症，与显著的发病率和死亡率相关。尽管发病率和死亡率很高，但美国大多数急性护理机构在癫痫持续状态（SE）期间或之后无法通过脑电图监测来评估患者。开展本研究以确定标准治疗方案对CSE的控制是否足以终止脑电图痫性发作。
在弗吉尼亚医学院/弗吉尼亚联邦大学癫痫持续状态项目中对164例前瞻性患者进行了评估。在CSE临床控制后进行至少24小时的持续脑电图监测。SE和癫痫发作类型如前所述进行定义。为每位患者编制了标准化的数据表录入系统，并用于评估收集到的数据。
CSE得到控制后，持续脑电图监测显示52%的患者没有SE后发作期放电（ASIDS），表现出脑电图模式为广泛性减慢、波幅衰减、周期性一侧性癫痫样放电（PLEDS）、局灶性减慢和/或爆发抑制。其余48%的患者表现出持续性脑电图痫性发作。超过14%的患者主要表现为非惊厥性癫痫持续状态（NCSE），为复杂部分性NCSE发作（CPS）类型（2）。这些患者昏迷，没有惊厥活动的明显临床体征。如果不使用脑电图监测，通过常规神经学评估不可能在这些患者中临床检测到NCSE。报告了该人群的临床表现、死亡率、发病率和人口统计学信息。
我们的结果表明，CSE治疗后的脑电图监测对于识别对CSE常规治疗无反应的持续性脑电图痫性发作和NCSE至关重要。这些发现还表明，CSE控制后立即进行脑电图监测是一项重要的诊断测试，可指导治疗方案并评估SE管理中的预后。
