New-onset refractory status epilepticus
New-onset refractory status epilepticus
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DOI：
10.1212/wnl.0000000000001940
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发表时间：
2015-11-03
期刊：
影响因子：
9.9
通讯作者：
Hirsch, Lawrence J.
中科院分区：
文献类型：
--
作者：
Gaspard, Nicolas;Foreman, Brandon P.;Hirsch, Lawrence J.
目的：本研究的目的是确定新发难治性癫痫持续状态的病因、临床特征和结果预测因素。方法：对 2008 年 1 月 1 日至 2013 年 12 月 31 日期间在 13 个学术医疗中心入院 48 小时内未发现病因的难治性癫痫持续状态患者进行回顾性分析。主要结局指标是出院时功能不良（定义为改良Rankin量表得分>3）。结果：130例病例中，67例（52%）仍为隐源性。最常见的病因是自身免疫性（19%）和副肿瘤性（18%）脑炎。 125 例（62 例是隐源性病例）的完整数据可用。 125 例中有 77 例（62%）预后不良，28 例（22%）死亡。不良结果的预测因素包括癫痫持续状态的持续时间、麻醉药的使用和医疗并发症。在有可用随访数据（中位 9 个月）的 63 名患者中，36 名患者（57%）的功能状态得到改善； 79% 的患者在最后一次随访中获得良好或一般的结果，但 37% 的患者出现癫痫，大多数幸存者 (92%) 仍在服用抗癫痫药物。尽管炎症性脑脊液变化的发生率相当，但在隐源性病例中，免疫疗法的使用频率较低。结论：自身免疫性脑炎是新发难治性癫痫持续状态最常见的病因，但一半仍为隐源性。出院时的结果很差，但在随访期间有所改善。大多数情况下都会发生癫痫。麻醉剂和免疫疗法的作用值得进一步研究。
Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.Methods: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).Results: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes.Conclusions: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.