| Objective: To investigate the clinical,EEG characteristics,treatment and prognosis of non-convulsive status epilepticus to guide clinical understanding of the disease,early detection,and timely treatment.Methods: The clinical data of patients diagnosed as non-convulsive status epilepticus in neurology department of the First Hospital of Jilin University from September 2016 to February 2018 were retrospectively analyzed.Results: A total of 53 patients were collected,(1)30 males and 23 females,male: female = 1.30: 1.The average age of onset was 57.04 ± 17.67 years.(2)Personal history and past medical history: There are 2 cases of family history,1 case of abnormal birth history;2 cases of history of febrile seizures.Previous history of cerebrovascular disease in 9 cases.17 cases of epilepsy history;6 cases of cerebral traumatic injury history;5 cases of brain surgery history;2 cases of history of intracranial infection;1 case of brain tumor history;1 case of autoimmune encephalitis.(3)etiology and causes: according to the time relationship between the etiology and the onset of NCSE,the etiology was divided into three groups: acute cause group,chronic cause group,and unclear cause group.Acute etiology group of 30 cases,including 15 cases of viral encephalitis,8 cases of autoimmune encephalitis,2 cases of acute cerebral hemorrhage,1 case of neurosyphilis,1 case of hypoxic-ischemic encephalopathy,1 case of respiratory failure,1 case of alcohol withdrawal and 1 case of acute cerebral infarction.There were 22 cases of chronic etiology,14 cases of epilepsy,2 cases of traumatic injury,2 cases of craniocerebral operation(1 case of cerebral hemorrhage and 1 case of trauma),Cerebral infarction sequelae in 2 cases,dementia in 1 case,intracranial mass lesions 1 case;unknown cause etiology group 1 case.The causes of chronic etiology were non-standard use of antiepileptic drugs in 5 cases,1 case of euthyroid withdrawal,1 case of pregnancy.(4)Types of seizure: 31 cases(58.5%)of focal NCSE with impaired awareness,15 cases(28.3%)of NCSE with coma,5 cases(9.4%)of focal NCSE without impaired awareness and 2 cases(3.7%)of ASE.(5)clinical manifestations: 17 cases of changes in the level of awakeness,17 cases of abnormal consciousness,mental disorders in 19 cases,memory and cognitive impairment in 12 cases,4 cases of sensory abnormalities,head and eye deflection in 3 cases,5 cases of hand autonomy,No purpose of walking in 2 cases,speech repeat in 1 case.(6)EEG manifestations in background,interictal period,and ictal period: 7 cases(13.2%)were normal in EEG background,and 46 cases(86.8%)were abnormal in background.There were 44 cases(83.0%)of abnormal discharge(between the frontal area,temporal area,occipital area,central area,multifocal,one-sided,diffuse)monitored during the interictal period,and 9 cases(17%)were normal.In the ictal period,20 cases(37.7%)were originated from the frontal area,15 cases(28.3%)from the temporal region,6 cases(11.3%)from the occipital region,3 cases(5.7%)from the central region,2 cases(3.8%)from the parietal region,5 cases(9.4%)from the multifocal origin,and 2 cases(3.8%)from the full-conduction discharge.During the ictal period,there were 5 cases(9.4%)of EDs with ?2.5 Hz,18 cases(34.0 %)of EDs with 2.5 ~ 5 Hz,14 cases(26.4%)of EDs with 5 ~ 10 Hz,6 cases(11.3%)of ? activity in> 0.5Hz,5 cases(9.4%)in ? activity and 5 cases(9.4%)of LPDs.In this group of patients,continuous electroencephalogram monitoring was intercepted for one hour for analysis.Among them,11 cases had continuous seizure?30min(interval ?3s),and the remaining 42 cases had 2 to 20 seizures.the median duration of seizures between 8s and 19min2s;the median duration of seizures was between 12 s and 10min18s;the interval between seizures was between 2s and 32min47s;the median time of interval between seizures was between 5s and 25min53 s.(7)Imaging: 46 of 53 patients underwent head MRI or CT scans,7 were normal;multiple abnormal signals,inflammation were considered in 12 cases;11 were multiple lacunar infarcts and 4 were changed after craniocerebral surgery;Large low-density film,considered cerebral infarction in 4 cases;cerebral hemorrhage in 2 cases;hippocampus high signal in 1 case;acute large area cerebral infarction in 1 case,frontal lobe occupancy in 1 case;brain Contusion,subdural hematoma in 1 case;abnormal signal,unclear in nature in 2 cases.(8)Complications: Electrolyte disorders(low sodium,low chloride,low potassium,high potassium,high sodium,high chloride,etc.)occurred in 30 patients(56.6%),hypoproteinemia in 30 patients(56.6%),and lung infections in 28 cases(52.8%),liver function impairment in 18 cases(34.0%),anemia in 15 cases(28.3%),venous thrombosis in 11 cases(20.7%),respiratory failure in 9 cases(20.0%),urinary tract infection in 7 cases(13.2 %),6 cases of renal impairment(11.3%),3 cases of severe infection(5.7%),1 case of gastrointestinal bleeding(1.9%).(9)Treatment: only oral new broad-spectrum antiepileptic drugs(levetiracetam,topiramate,etc.)in 17 cases,Only the first line of diazepam was used in 13 patients,there were 10 patients with poor first-line drug control and second-line valproic acid or valproic acid combined with phenobarbital.The first-and second-line drugs were poorly controlled,There were 9 patients with midazolam as the third-line sedative drug and 2 patients with propofol as the anesthetic agent.No anti-epileptic drug was used.2 cases.(10)Prognosis: The long-term prognosis of the patients was divided into 4 levels: Level 1 was no seizure after complete cure,2 was occasional seizures(improved >50%),and 3 was frequent seizures or NCSE failed to control(Improved <50% earlier),4th is death.Of these,22 cases(41.5%)were in grade 1,18 cases(34.0%)in grade 2,7 cases(13.2%)in grade 3,and 6 cases(11.3%)in grade 4..Conclusion: 1.The incidence rate of NCSE in the elderly is higher than young people.2.In acute etiology,intracranial infections and other inflammatory lesions are the most common.Epilepsy is the most common cause of chronic etiology,and is partly induced by non-standardized administration of drugs.There is no difference in the prognosis of acute and chronic etiologies.3.The incidence of focal NCSE with impaired awareness in adult NCSE is the highest.The prognosis of focal NCSE With impaired awareness is better than that of NCSE with coma.The control effect of NCSE with coma is the worst.4.The prevalence of ictal discharge of frontal origin was the most,and the epileptic discharge(EDs)were the most common type,and seizures are always short-term frequent episodes. |
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