Factors associated with long-term outcomes in pediatric refractory status epilepticus.
Factors associated with long-term outcomes in pediatric refractory status epilepticus.
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本研究旨在描述儿童难治性癫痫持续状态（RSE）的长期临床和发育结局，并确定与RSE后新发神经功能缺损相关的因素。我们对2011年6月至2020年3月前瞻性收集的RSE儿科患者的观察数据进行了回顾性分析。我们分析了RSE后至少30天的临床结果，在亚组分析中，我们评估了以前正常发育的患者的发育结果和风险因素。276例患者（56.5%为男性）的结局随访数据可用。中位（四分位距[IQR]）随访时间为1.6（.9-2.7）年。住院死亡率为4%（16/403例患者），15例（5.4%）患者在出院后死亡。166例（62.9%）患者随后发生了无端癫痫发作，44例（16.9%）患者发生了反复RSE发作。在116例RSE前发育正常的患者中，42/107例（39.3%）有可用数据的患者有新的神经功能缺损（认知、行为或运动）。新发功能障碍患者的中位（IQR）电临床RSE持续时间长于无新发功能障碍患者（10.3 [2.1-134.5] h vs. 4 [1.6-16] h，p = 0.011，校正比值比= 1.003，95%置信区间= 1.0008-1.0069，p = 0.027）。功能结局不良（格拉斯哥结局量表扩展评分≥ 4）的患者比例为22/90（24.4%），他们更有可能接受连续输注。大约三分之一的患者没有以前的癫痫发作后，RSE发作复发无缘无故的癫痫发作。在先前正常发育的患者中，39%在随访期间出现新的功能缺陷，电临床RSE持续时间较长是预测因素。
This study was undertaken to describe long‐term clinical and developmental outcomes in pediatric refractory status epilepticus (RSE) and identify factors associated with new neurological deficits after RSE. We performed retrospective analyses of prospectively collected observational data from June 2011 to March 2020 on pediatric patients with RSE. We analyzed clinical outcomes from at least 30 days after RSE and, in a subanalysis, we assessed developmental outcomes and evaluated risk factors in previously normally developed patients. Follow‐up data on outcomes were available in 276 patients (56.5% males). The median (interquartile range [IQR]) follow‐up duration was 1.6 (.9–2.7) years. The in‐hospital mortality rate was 4% (16/403 patients), and 15 (5.4%) patients had died after hospital discharge. One hundred sixty‐six (62.9%) patients had subsequent unprovoked seizures, and 44 (16.9%) patients had a repeated RSE episode. Among 116 patients with normal development before RSE, 42 of 107 (39.3%) patients with available data had new neurological deficits (cognitive, behavioral, or motor). Patients with new deficits had longer median (IQR) electroclinical RSE duration than patients without new deficits (10.3 [2.1–134.5] h vs. 4 [1.6–16] h, p = .011, adjusted odds ratio = 1.003, 95% confidence interval = 1.0008–1.0069, p = .027). The proportion of patients with an unfavorable functional outcome (Glasgow Outcome Scale‐Extended score ≥ 4) was 22 of 90 (24.4%), and they were more likely to have received a continuous infusion. About one third of patients without prior epilepsy developed recurrent unprovoked seizures after the RSE episode. In previously normally developing patients, 39% presented with new deficits during follow‐up, with longer electroclinical RSE duration as a predictor.
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