| Objective:To investigate the clinical characteristics,treatment and efficacy of anaesthetic in pediatric super refractory status epilepticus(SRSE),and to explore the risk factors of outcome of SRSE in Children.Methods:Collect the clinical information of SRSE in 85 patients from 729 patients with SE who admitted to Children’s Hospital of Chongqing Medical University,from January 2012 to December 2016.Summarize the Etiology,clinical characteristics,auxiliary examinations,treatment and short-term outcome at discharge.The efficacy of different anesthetic and the risk factors related to short-term outcome were performed by using?~2 and Logistic regression analysis respectively.Results:1.SRSE account for 11.65%of SE.The mean age of children with SRSE is 55.81±51.12 months.There are 47 males and 38 females.The peak onset season is in winter.2.Central nervous system infection is the main cause of SRSE(30.56%,26/85),in which viral encephalitis,purulent meningitis and tuberculous meningitis account for 23.54%,5.88%and 1.17%respectively.Secondly in etiology are epilepsy(20.00%),FIRES encephalitis(12.95%),toxic encephalopathy(7.06%),hypoxic ischemic encephalopathy(5.88%),intracranial hemorrhage and autoimmune encephalitis account for 1.17%,and about 21.18%are unknown.3.The seizure type of SRSE are varied,include focal seizures and generalized seizures,which account for 36.50%and 63.50%.The most common types are focal clonic seizures(45.88%),generalized clonic seizures(18.86%)and focal myoclonic seizures(15.28%).4.The EEG of SRSE include:background diffuse slow wave(71.76%),focal slow wave(1.25%),focal discharges(21.25%),Multifocal discharges(22.50%),generalized low voltage(15.00%),electrical status epilepticus(8.75%),burst suppression(7.50%),periodic discharges(3.75%).Different types of EEG could be seen in one SRSE patients.5.Midazolam is the preferred anesthetic for children with SRSE.The average period of analgesic treatment is 7.79±6.27 days.The effective rate of midazolam in SRSE is 29.31%,while the efficiency of midazolam combined with propofol is 34.62%.There is no significant difference in the efficacy of midazolam monotherapy or combined with propofol in the treatment of SRSE(P>0.05).6.It is difficult to treat SRSE.Anesthetic combined with AEDs are the most choice of treatment,and hypothermia treatment,immunotherapy,surgical treatment and other treatment could be thinking about when the treatment is failure.At discharge,the good short-term prognosis of SRSE is only 35.29%,while poor short-term prognosis of SRSE is 64.71%.Seizure control after anesthetic may affect short-term prognosis by Logistic regression analysis(OR=0.294,P=0.049).7.The rate of fatality and disability of SRSE are high.In the follow-up 38 cases,28 cases died(73.68%),only 2 cases have no obvious nervous system disorders in 10 survivors,8 cases have epilepsy and other neurological dysfunction,including mental retardation in 7 cases,movement disorders in 5 cases,memory impairment in 1 case.Conclusion:1.SRSE is an extremely refractory stage for the status epilepticus.The central nervous system infection is the most common cause,and epilepsy and FIRES encephalitis are also common,while some causes of SRSE are still unknown.2.The seizure type and EEG of SRSE are varied,and focal onset is more common.3.It is difficult to treat SRSE.Anesthetic combined with AEDs are the most choice of treatment,and Midazolam is the preferred anesthetic for children with SRSE.There is no significant difference in the efficacy of midazolam monotherapy or combined with propofol in the treatment of SRSE.Hypothermia treatment,immunotherapy,surgical treatment and other treatment could be thinking about when the treatment is failure.4.The rate of fatality and disability of SRSE are high.Seizure control after anesthetic may affect short-term prognosis... |
PDF Full Text Request