Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes
Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes
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DOI：
10.1111/epi.14607
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发表时间：
2019-01-01
期刊：
影响因子：
5.6
通讯作者：
Siebert, Uwe
中科院分区：
文献类型：
--
作者：
Leitinger, Markus;Trinka, Eugen;Siebert, Uwe
目的2015年，国际抗癫痫联盟（ILAE）提出了癫痫持续状态（SE）的新定义：5分钟持续发作活动诊断惊厥性SE (CSE，即双侧强直-阵挛性SE)， 10分钟诊断局灶性SE和缺席性SE，而不是以前的标准30分钟。基于符号学，将几种在任何时间有明显运动现象的SE（包括CSE）与没有运动现象的SE（即非惊厥性SE、NCSE）区分开来。我们提出了第一个基于人群的发病率研究，应用新的2015年ILAE定义和SE分类，并报告了符号学和意识水平（LOC）的进化对结果的影响。方法：我们对2011年1月至2015年12月居住在萨尔茨堡市的所有成年SE患者进行了一项基于人群的回顾性发病率研究。排除了患有缺氧脑病的患者。根据ILAE 2015对SE进行定义和分类。结果221例患者中位年龄为69岁（范围20-99岁）。经年龄和性别调整后，SE、NCSE和SE首次发作并伴有明显运动现象（包括CSE）的发生率分别为每10万成年人每年36.1例（95%可信区间[CI] 26.2-48.5）、12.1例（95% CI 6.8-20.0）和24.0例（95% CI 16.0-34.5；包括CSE 15.8例[95% CI 9.4-24.8]）。以双侧强直-阵挛活动结束或仅由双侧强直-阵挛活动组成的患者无一死亡。在所有其他临床表现中，清醒患者的病死率（8.2%）低于意识受损患者（33%）。这项首次基于人群的研究使用了ILAE 2015的SE定义和分类，发现与以前的定义相比，SE的发病率增加了10%。我们还提供了流行病学证据，表明不同的状态演变模式和loc具有很强的预后意义。
Objective In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic-clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population-based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome. Methods We conducted a retrospective population-based incidence study of all adult patients with SE residing in the city of Salzburg between January 2011 and December 2015. Patients with hypoxic encephalopathy were excluded. SE was defined and classified according to the ILAE 2015. Results We identified 221 patients with a median age of 69 years (range 20-99 years). The age- and sex-adjusted incidence of a first episode of SE, NCSE, and SE with prominent motor phenomena (including CSE) was 36.1 (95% confidence interval [CI] 26.2-48.5), 12.1 (95% CI 6.8-20.0), and 24.0 (95% CI 16.0-34.5; including CSE 15.8 [95% CI 9.4-24.8]) per 100 000 adults per year, respectively. None of the patients whose SE ended with or consisted of only bilateral tonic-clonic activity died. In all other clinical presentations, case fatality was lower in awake patients (8.2%) compared with patients with impaired consciousness (33%). Significance This first population-based study using the ILAE 2015 definition and classification of SE found an increase of incidence of 10% compared to previous definitions. We also provide epidemiologic evidence that different patterns of status evolution and LOCs have strong prognostic implications.