Assessment of acute morbidity and mortality in nonconvulsive status epilepticus
Assessment of acute morbidity and mortality in nonconvulsive status epilepticus
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DOI：
10.1212/01.wnl.0000082653.40257.0b
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发表时间：
2003-10-28
期刊：
影响因子：
9.9
通讯作者：
Fountain, NB
中科院分区：
文献类型：
--
作者：
Shneker, BF;Fountain, NB
目的：非惊厥性癫痫持续状态（NCSE）的自然史尚未明确，尤其是死亡率和发病率。作者假设，当NCSE是由于急性医学原因（全身性或神经性）或与严重精神状态损害或急性并发症相关时，NCSE的死亡率较高，而当与EEG上的全身性棘波（SW）放电相关时，NCSE的死亡率较低。方法：作者回顾性地从EEG数据库中确定了100例连续NCSE患者。数据收集自医疗记录和实际EEG描记的系统回顾。具体病因分为三组：急性内科、癫痫和隐源性。结果：100例患者中，18例死亡。急性医学组52例患者中有14例死亡，癫痫组31例患者中有1例死亡，隐源性组17例患者中有3例死亡。33例精神状态损害严重，39例发生并发症，36例发生全身SW放电。急性药物组患者的死亡率（27%）高于癫痫组（3%）和隐源性组（18%）（2）重度精神状态损害组（39%）与轻度精神状态损害组相比，差异有显著性（P < 0.02）（3）急性并发症（36%）与无并发症（7%）比较，P < 0.0002。EEG上普遍SW放电的存在与死亡率无关。精神状态损害和病因与死亡率独立相关（p < 0.001）。结论：NCSE与死亡率相关。死亡率与作为潜在病因的急性医学原因、严重精神状态损害和急性并发症的发生相关，但与EEG放电类型无关。
Objectives: The natural history of nonconvulsive status epilepticus (NCSE) is not well defined, especially mortality and morbidity. The authors hypothesized that the mortality of NCSE is higher when NCSE is due to acute medical causes ( systemic or neurologic) or associated with severe impairment of mental status or with acute complications, and lower when associated with generalized spike-wave ( SW) discharges on EEG. Methods: The authors retrospectively identified 100 consecutive patients with NCSE from an EEG database. Data were collected from systematic review of medical records and actual EEG tracings. Specific etiologies were divided into three groups: acute medical, epilepsy, and cryptogenic. Results: Of the 100 patients, 18 died. Fourteen of 52 patients in the acute medical group died, 1 of 31 in the epilepsy group died, and 3 of 17 in the cryptogenic group died. Mental status impairment was severe in 33, complications occurred in 39, and generalized SW discharges occurred in 36. Mortality rates were higher in patients 1) in the acute medical group (27%) vs the epilepsy (3%) and the cryptogenic (18%) groups ( p < 0.02), 2) with severe mental status impairment (39%) compared to those with mild impairment (7%, p < 0.001), and 3) with acute complications (36%) when compared with those without complications ( 7%, p < 0.0002). The presence of generalized SW discharges on EEG did not correlate with mortality. Mental status impairment and etiology were independently associated with mortality ( p < 0.001). Conclusion: NCSE is associated with substantial mortality. Mortality is associated with an acute medical cause as the underlying etiology, severe mental status impairment, and development of acute complications, but not the type of EEG discharge.