PATHOPHYSIOLOGY AND MORTALITY OF STATUS EPILEPTICUS

描述（由研究者提供）：癫痫持续状态（SE）与显著的死亡率相关，但对死亡的病理生理学基础知之甚少。此外，没有结局量表来预测SE的死亡概率。本研究将探讨SE和非惊厥性SE（NCSE）死亡率的预测因素。初步结果（PR）表明，我们为SE和NCSE开发的结局量表预测死亡率具有高度的特异性和敏感性。这些结果量表将在本研究中进行前瞻性验证和改进。我们的PR将SE发作后放电（ASIDS）确定为SE患者死亡率和心脏异常的主要预测因素。建议进行研究以确定ASIDS在引起心脏电生理和功能异常中的作用。PR表明ASIDS可引发急性心脏失代偿和死亡。本研究将检验我们最初的观察结果，即ASIDS的频率和持续时间增加与死亡率增加相关。我们还将通过连续的脑电图和心电图监测来确定ASIDS是否与心脏电生理异常及时相关并可能引发死亡。我们还建议对监测的SE患者和对照组的大脑和心脏的病理结果进行尸检研究。我们的PR表明SE引起海马和丘脑的急性缺血性和神经胶质样改变，并与特定的心脏病理学有关。将在以下5个具体目标中检验假设。目的1：验证NCSE结局量表预测NCSE死亡率的有效性.目的2：确定ASIDS的频率和持续时间对SE死亡率的影响。目的3：确定ASIDS与心脏电生理和/或功能异常和死亡的时间关系。目的4：确定死亡前CNS和CVS功能异常，并与脑和心脏病理结果相关联。目的5：验证SE结局量表预测SE死亡率的能力。这项研究可能会提供显着的见解，在SE的死亡率的原因，也制定了结果量表SE和NCSE，可用于在床边，以确定高风险的情况。识别高风险SE和NCSE病例的能力将为高风险病例的新治疗策略的开发提供新的希望，以防止SE死亡，并为咨询家庭提供有关预后的指导。

DESCRIPTION (provided by investigator): Status Epilepticus (SE) is associated with significant mortality, yet little is known concerning the pathophysiological basis of death. Furthermore, there are no outcome scales to predict the probability of mortality in SE. This study will investigate predictors of mortality for SE and non convulsive SE (NCSE). Preliminary results (PR) indicate that we developed Outcome Scales for both SE and NCSE that predict mortality with a high degree of specificity and sensitivity. These Outcome Scales will be prospectively validated and improved in this study. Our PR identified After SE Ictal Discharges (ASIDS) as a major predictor of mortality and cardiac abnormalities in SE. Studies are proposed to determine the role of ASIDS in causing cardiac electrophysiological and functional abnormalities. PR indicates that ASIDS can trigger acute cardiac decompensation and death. This study will test our initial observations that increased frequency and duration of ASIDS are associated with increased mortality. We will also determine by continuous EEG and ECG monitoring whether ASIDS are associated in time with cardiac electrophysiological abnormalities and can trigger death. We also propose to conduct postmortem studies on the pathological findings in brain and heart in monitored SE patients and controls. Our PR indicated that SE causes acute ischemic and gliotic changes in the hippocampus and thalamus and is associated with specific cardiac pathology. Hypotheses will be tested in the following 5 Specific Aims. AIM 1: Prospectively validate the NCSE Outcome Scale to predict mortality in NCSE. Aim 2: Determine the effect of frequency and duration of ASIDS on mortality in SE. Aim 3: Determine the temporal relationship of ASIDS and cardiac electrophysiological and/or functional abnormalities and death. AIM 4: Determine CNS and CVS functional abnormalities prior to death and correlate with brain and heart pathologic findings. AIM 5: Prospectively validate the ability of the SE Outcome Scale to predict mortality in SE. This study may provide significant insights into the causes of mortality in SE and also develop Outcome Scales for both SE and NCSE that can be used at the bedside to identify high risk cases. The ability to recognize high risk SE and NCSE cases will offer new hope for the development of new treatment strategies for high risk cases to prevent death in SE and provide guidelines to counsel families regarding prognosis.