| Objective:To study the clinical features, treatment and prognosis of Status epilepticus in Northeast of China.Methods:Retrospectively analyzing the clinical data of status epilepticus patients hospitalized in the First Hospital of Jilin University from January 2011 to May 2015,we also collect the outcome and prognosis through telephone or outpatient follow-up. Results:223 status epilepticus patients are include in this study,(1)121 males and 102 females, male : female=1.91:1. Age of onset range from 0.25y~91y, mean age is 28.85±25.58 y.(2) Past history and Family history: 88 cases had a history of epilepsy or epilepsy seizures; 27 cases had Severe brain injury and / or a history of brain surgery; 17 cases had Centrel Nervous system(CNS) infection history; 14 cases had Abnormalities at birth; 12 cases had growth abnormalities; 10 cases had a history of febrile seizures. 9 patients have a family history of epilepsy/epilepsy seizure, 7 cases`s first-degree relatives and 2 cases`s seconddegree relatives had experienced one or more seizures, or have been diagnosed epilepsy.(3) Etiology and incentives: 215(96.41%) patients have dedinite etiology and/or incentives, including 106(47.53%)epilepsy patients,81(36.32%)CNS infection patients, 8(3.60%)limbic encephalitis patients, 7(3.15%) patients with Metabolic disorders, 6(2.70%)Acute cerebral infarction patients, 2(0.90%)nervous system degeneration patients, 2(0.90%)Encephalopathy patients, 1(0.45%)Withdrawal syndrome patient and(10.45%) venous sinus thrombosis patient. Acute incentives include CNS infection, Metabolic disorder, Acute cerebral infarction and the chronic incentives: Patients with epilepsy can develop SE for various reasons including reduced serum drug levels from poor adherence with treatment regimens.(4) Classification: 200(89.69%) cases With prominent motor symptoms, including 9(4.04%) focal moter SE patients, 20(8.97%) global tonic-clonic status epilepticus(GTSE) cases, 74(31.83%) secondery global tonic-clonic status epilepticus(SGTSE) cases and 97(43.50%) Unknown whether focal or generalized convulsive cases; There are 23(10.31%) nonconvulsive status epilepticus(NCSE) cases, including 1(0.45%) NCSE with coma, 1(0.45%) absence status, 1(0.45%) aura continua and 20(8.97%) focal SE With impaired consciousness.(5) Electroencephalogram(EEG): 183(82.06%) cases complete EEG, and 156(85.25%) cases show abnormalties. Abnormal EEG mainly as :133(85.26%) cases have abnormal background EEG amplitude adjustment or abnormal background activity reduction, α rhythm disintegration, background rhythm disappeared and the emergence of slow activity; 77(39.36%) cases have abnormal interictal events as scattered or paroxysmal sharp waves, spikes, sharp slow spike slow wave or diffuse slow activity. 64(41.03%) cases have clinical or subclinical seisures, including 37(23.72%) SE Patients and 27(17.31%) patients who have clinicl or subclinical discharges.(6) Imaging manifestations: there are 201 cases have had CT or MRI examination, and 153(76.12%) cases have abnormal imaging menifestations.42(70%) in 60 cases who have had CT examination are abnormal, including 24 cases of one side of hemisphere abnormalities and 13 cases of two sides of hemisphere abnormalties. The former include 21 cases of unilateral cerebral cortex of one or more low density, 2 cases of unilateral ventricle white matter/ basal ganglia abnormalties and 1 case with a lobe high signal; The latter include 6 cases of two or more low density cerebral cortex, 9 cases of Bilateral multiple low density and 3 cases of frontotemporal subarachnoid widened. 111(78.72%) in 141 cases have abnormal MRI examination, including 45(40.91%)cases of Side of the lesion, 60(54.55%)cases two sides of the lesion, 4(3.64%)cases of Corpus callosum pathological changes and 1(0.91%)Pontine infarct.(7) The outcome of therapy: 50 cases have spontaneous remission, and 84 cases have been completely Controled; there are 64 Refractory status epilepticus(RSE) cases and 25 Super-refractory status epilepticus(SRSE) cases. 200(89.69%) cases are respond to measures, including spontaneous remission cases, completely Controleda cases and not fully controlled cases. 15(6.73%) cases died in hospital, including 11 multiple organ failure cases,1 cardiac arrest case, 1 respiratory failure case and 2 other cases who die of cortico-spinal cord- striatal degeneration and nasopharyngeal.(8) complication: there are 127 cases have complicationgs. The common complications include acute upper respiratory tract infection(23.77%), pneumonia(16.14%), Water and electrolyte acid-base balance disorders(12.56%), respiratory failure(9.42%), acute myocardial injury(6.28%), multiple organ failure(3.34%).(9)Prognosis: There are 24 died. 15 cases died in hospital and 9 cases died after discharge without seizure events. Telephone follow-up all patients, and lost 25 cases with a dropout rate of 11.21%. About 15.15% patients still experience frequent seizures. About 15.65% cases experience seizure occasionally and 57.07% cases are seizure free. Conclusion:1. SE can occur at any age, and 0-9 year of age and the elderly population are the two common ages onset. middle-aged and elderly patients are mainly male. 2. CNS infection and epilepsy are the most common causes of SE. The commen acute etiology/incentives include CNS infection, fever, metabolitic disorders and aute stroke; The commen chronic etiology/incentives : Patients with epilepsy can develop SE for various reasons including reduced serum drug levels from poor adherence with treatment regimens or without treatment. 3. SE with prominent motor symptoms is significantly more than NCSE, and CSE is the most common type. 4. SE overall prognosis is good, generally not left sequelae.The mortality rate in our study is 6.73%. SE patients are more likely die of multi-organ failure or the primary disease. NCSE patients have a better prognosis than CSE patients. |
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