DeLorenzo R J, Garnett L K, Towne A R, Waterhouse E J, Boggs J G, Morton L, Choudhry M A, Barnes T, Ko D
Department of Neurology, Virginia Commonwealth University, Richmond 23298-0599, USA.
Epilepsia. 1999 Feb;40(2):164-9. doi: 10.1111/j.1528-1157.1999.tb02070.x.
Status epilepticus (SE) is a major medical and a neurologic emergency associated with significant morbidity and mortality. The current definition of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting > or =30 min. Epilepsy monitoring unit data indicate that many seizures self-terminate within minutes. Thus consideration was recently given to include seizure episodes lasting > or =10 min in the definition of SE. Because no large studies have been conducted on seizures lasting 10-29 min, this study was initiated to compare cases of SE and 10 to 29-min seizure episodes seen within the same period.
Patients seen at the Medical College of Virginia Hospitals of Virginia Commonwealth University over the same 2-year period were studied. Two hundred twenty-six prospective SE cases (91 children and 135 adults) and 81 retrospective 10- to 29-min seizure episodes (31 children and 50 adults) were compared. A standardized data-entry-form system was compiled on each patient and was used to evaluate the data collected.
The 10- to 29-min seizure patients and the SE cases had similar demographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) treatment to control and stop seizure activity. In the 10- to 29-min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED treatment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 10- to 29-min group (p<0.001). In the 10- to 29-min group that stopped seizing spontaneously, the mortality was 0. In the 10- to 29-min patients that required AED treatment, the mortality was 4.4%.
The results demonstrate that a significant number of patients experience seizure activity lasting from 10- to 29-min. Approximately half of these seizure events stopped spontaneously and did not require AED treatment. The other half of the patients responded quickly to medications and stopped seizing before the 30-min definition for SE. The overall mortality of this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10- to 29-min seizure group are needed to differentiate seizures that will stop spontaneously and those that will only stop with AED treatment. Because almost half of the prolonged seizures stopped spontaneously, further studies are needed before including prolonged seizure activity in the definition of SE.
癫痫持续状态（SE）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。SE的当前定义是持续的癫痫发作活动或间歇性癫痫发作活动且未恢复意识，持续时间≥30分钟。癫痫监测单元的数据表明，许多癫痫发作在数分钟内自行终止。因此，最近有人考虑将持续时间≥10分钟的癫痫发作纳入SE的定义。由于尚未对持续10 - 29分钟的癫痫发作进行大型研究，本研究旨在比较同期出现的SE病例与持续10至29分钟的癫痫发作病例。
对弗吉尼亚联邦大学弗吉尼亚医学院医院在同一2年期间就诊的患者进行研究。比较了226例前瞻性SE病例（91名儿童和135名成人）和81例回顾性持续10至29分钟的癫痫发作病例（31名儿童和50名成人）。为每位患者编制了标准化的数据录入表单系统，并用于评估收集到的数据。
持续10至29分钟的癫痫发作患者与SE病例具有相似的人口统计学特征，如性别、种族和年龄，病因也相似。大多数（93%）SE病例需要抗惊厥药物（AED）治疗来控制和终止癫痫发作活动。在持续10至29分钟的组中，43%的患者癫痫发作自行终止，其余（57%）需要AED治疗来终止癫痫发作活动。SE患者的死亡率为19%，而持续10至29分钟组的死亡率为2.6%（p<0.001）。在自行终止癫痫发作的持续10至29分钟组中，死亡率为0。在需要AED治疗的持续10至29分钟患者中，死亡率为4.4%。
结果表明，相当数量的患者经历持续10至29分钟的癫痫发作活动。这些癫痫发作事件中约一半自行终止，无需AED治疗。另一半患者对药物反应迅速，在达到SE的30分钟定义之前癫痫发作停止。该组的总体死亡率显著低于SE患者。结果表明，需要对持续10至29分钟的癫痫发作组进行进一步研究，以区分会自行终止的癫痫发作和仅需AED治疗才能终止的癫痫发作。由于几乎一半的长时间癫痫发作会自行终止，在将长时间癫痫发作活动纳入SE定义之前，还需要进一步研究。
