| Status Epilepticus (SE) is one of the most common neurological diseases which is acute and severe. It is a devastating neurological condition with complicated etiological factors and risk factors. The morbidity and mortality is high if it is not treated immediately. With deeper understanding of SE, we found that SE has a highly heterogeneous. The differences are not only the forms but also the prognosis and outcome. So it is hard for doctors to diagnose and treat in SE patients. In this paper, a statistical analysis was done on clinical data of 98 SE patients. We investigated the risk factors of SE to explore the early-warning value of the risk factors and provide a basis for clinical treatment of high-risk groups, prevention of the occurrence and recurrence of SE. Meanwhile, we investigated the clinical features, treatment methods of SE to find the effective therapeutic scheme for SE patients and explored the prognosis factors of SE to reduce the mortality and disability.Part One Analysis of Risk Factors and Early-warning in Status Epilepticus PatientsObjective:To investigated the risk factors of SE and explore the early-warning value of the risk factors.Object:The SE patients were enrolled between January 2001 and November 2009 from Department of Neurology of Xijing Hospital.Inclusion criteria: 1. Epileptic activity that continues for over 30 min, either as a single seizure or as recurrent seizures without inter-ictal return of consciousness (ILAE, 1981) [1,2]; 2. The medical records were complete.Excluding criterion: 1. History, case records or clinical routine examination were not complete; 2. Seizure terminated on admission; 3. Patients without a continuous treatment for various reasons. Patients with any of these three standards can not be included. 98 SE patients were accorded with the criteria (69 male and 29 female; age ranging from 1 to 78 years; mean age 26.3±16.9 years; median age 21 years).Methods:1. Clinical data collection: The medical records of 98 patients with SE were collected by the inclusion criteria and analysed retrospectively. Meanwhile, the control group was randomly sampled from the 196 epilepsy patients who did not have SE by age-matched and sex-matched to perform the 1:2 matching case-control study.2. Statistical methods: The database was established by EXCEL, and then we analysed the data with SPSS 16.0 software. The significant difference was confined to P<0.05. Chi-square criterion was used to compare the incidence rate of demographic data, trigger factors and incentive factors. Logistic regression analysis was performed to determine significant contributors to SE.Results:1. Age: The onset age of SE was ranging from 1 to 78 years old, mean age was 26.3±16.9 years, median age 21 years.2. Sex: The incidence of SE in male and female were 70.41% and 29.59% respectively. It was clearly higher in the male group than that of female group.3. SE type: The proportion of non (17.35%) was less in SE than that of convulsive status epilepticus (82.65%).4. Multiple Logistic regression shows that the main risk factors for SE were acute viral encephalitis (OR of 4.55), cerebrovascular diseases (OR of 3.97), brain injury (OR of 1.811). And the prediction exactness rate of the model was 71.1%.5. The proportion of SE patients with the history of epilepsy was 47.96%, the outbreak of SE was related to the lack of AEDs blood concentration, abrupt drug withdrawal, trauma, respiratory infections with fever, alcohol abuse and so on.6. The incidence of SE which occurred as the first syndrome without epilepsy was 52.04%. It was associated with the trigger factors such as virus encephalitis, cerebrovascular diseases and brain injury.Conclusions1. The average onset age of SE was 26.3±16.9 years, and the median age was 21 years old. The incidence of SE in male was higher than female; and the incidence of SE which occurred as the first symptom without epilepsy history was 52.04%.2. Acute viral encephalitis, heavy stroke and brain injury are the main risk factors of SE.3. The main inducing factors were abrupt drug withdrawal, mental injury, respiratory infections with fever, etc.4. The incidence of SE which occurred as the first syndrome without epilepsy was most associated with acute brain lesions. Part Two Analysis of Treatment and Prognosis in SE PatientsObjectiveTo summarize and explore the therapy of SE, and find the prognosis factors of SE, in order to provide the basis for the treatment of SE .ObjectThe SE patients were enrolled between January 1999 and November 2009 from Department of Neurology of Xijing Hospital.Inclusion criteria: As part 1.Excluding criterion: 1. History, case records or clinical routine examination were not complete; 2. Seizure terminated on admission; 3. Patients without a continuous treatment for various reasons; 4. Patients with the history of severe neurological dysfunction; 5. Patients who have the history of psychiatric disorders. In conclusion, patients with any of these five standards can not be included.98 SE patients were accorded with the criteria. 69 male and 29 female; age ranging from 1 to 78 years, mean age 26.3±16.9 years, median age 21 years; 52 cases from city and 46 cases from country; 47 cases with epilepsy history and 51 cases with no epilepsy history; 95 cases were the first time occurring SE and 3 cases occurring repeatedly.Methods1. Clinical data collection: The medical records of 98 patients with SE were collected and analyzed retrospectively. The anti-epilepsy methods and EEG monitoring results were concluded.2. Evaluation of therapeutic efficiency. Criteria: 1. Effective treatment: the seizure can be controlled in 3 hours or at least reduced or turned to intermittent seizure; 2. Ineffective treatment: the seizure frequency did not decrease in 3 hours.3. All cases were followed up after their discharge for average 12 months for clinical assessment. The assessment was according to the Glasgow Outcome Score (GOS), which was divided into two parts: a. Excellent prognosis: of no mobility and mortality. b. Poor prognosis: patients with the occurence of dysphonia, mental retardation, limbs disturbance, vegetative state, death etc.4. Analyze the risk factors associated with prognosis.5. Statistical methods: The database was established by EXCEL, and then we transacted the data with SPSS 16.0 software.Results1. It is reliable to control seizure under the observation of vital signs, long-term EEG and serum drug concentration monitor. Also it is beneficial for the type classification, treatment adjustment and prognosis analyze.2. To better control the seizure, the selection of oral and other administration ways such as stomach tube injection, retention enema and vessel injection were recommended.3. It is effective to administer diazepam intravenously interruptedly and slowly with prolonged phenobarbital pumped in to control seizure. The effective rate was 59.18%. 4. Characteristics of EEG: Significantly higher frequency of occurrence was noted in continuous electroencephalogram(CEEG)of periodic or rhythmic spike wave, sharp wave, spike-slow, sharp-slow wave complex, extensive slow wave and rhythmic slow wave. The patient with multifocal epileptic discharge and lots of slow-waves after onset had a bad outcome.5. Effect: The effective rate was 91.84%. Pulmonary infection was the most common complication which consisted of 38.78%, and in which 28.95% were receiving mechanical ventilation.6. Prognosis: Generally, the prognosis of SE was significantly superior. The mortality was only 7.6%, the incidence of neurological deficits was 14.46%. The prognosis was relatively poor in CNS diseases, male, adult, CSE and patients complicated with pulmonary infection.Conclusions1. It is reliable and safe to use enough doses of AEDs to control seizure under the monitor of vital signs, long-term EEG and serum drug concentration.2. It is effective to control SE when combined administering diazepam intravenously with continuous phenobarbital pumped in with micromedicine infusion-pump.3. This paper reported a relatively lower mortality and disability rate comparing with other reports. The poor prognosis is related to the cause, CEEG after onset, male, adult, etc. |
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