Clinical Characteristics,Treatment And Prognosis Of Super-refractory Status Epilepticus In Adults

Objective:We investigate the clinical characteristics,treatment and prognosis of super-refractory status epilepticus in adults in order to improve the clinician's understanding of SRSE and the prognosis of patients.Methods:This study collected detailed information of patients diagnosed with SE clinically in the NICU ward of the First Hospital of Jilin University from January 2016 to February 2019 in order to select patients with SRSE for retrospective analysis.Results:A total of 150 patients with SE were enrolled during the target time including 39 patients with SRSE(39/150,26%).(1)General information: There were 21 males and18 females,male: female = 1.17:1,age of onset 18-67 years,mean age of onset was38.28±14.974 years old,and there was no significant difference in the average age of onset between men and women.There were 24 cases(24/39,62%)in the group from18 to 44 years old,11 cases(11/39,28%)in the middle age from 45 to 59 years old,and4 cases in the old age of 60 years old and older(4/39,10%).(2)Family history and past history: There were 13 cases(13/39,33%)with a history of epilepsy.(3)Etiology and causes: 39 patients were divided into 3 groups according to the relationship with SRSE: 26 patients(26/39,67%)in the acute etiology group and 11 patients(11/39,28%)in the chronic etiology group.2 cases(2/39,5%)were in the unexplained group.Viral encephalitis was the most common in the acute etiology group(15/26,58%),followed by autoimmune encephalitis(7/26,27%).Epilepsy was the most common in the chronic etiology group(8/11,73%).Irregular use of antiepileptic drugs is the most common cause of patients with chronic etiological factors.(4)Type of seizure: The types of seizures in this group of patients were classified according to the classification criteria for Status epilepsy developed by ILAE in 2015.There were 18patients(47%)with secondary generalized tonic-clonic status epilepticus(SGTSE);1patient(2%)with SGTSE combined with Myoclonic SE with coma;10 patients(26%)with SGTSE and NCSE with coma;7 patients(18%)with NCSE with coma;1 case(2%)with focal NCSE without impairment of consciousness;2 patients(5%)with Epilepsia partialis continu(EPC).Among them,29 patients(29/39,74%)had only one seizure type,and 10 patients(10/39,26%)had two seizure types.One seizure type is most common in SRSE patients.The most common type of seizure was SGTSE(18/39,47%),followed by SGTSE combined with NCSE with coma(10/39,26%).(5)EEG: EEG of 25 patients in 39 patients was monitored for Status epilepsy.When a patient's EEG recorded more than one Status epilepsy,only the first EEG results were analyzed.The background of EEG in 25 patients was abnormal.By analyzing the origin of the attack,it was found that the origin of the SRSE was not significantly related to the type of seizure due to the small sample size and diverse origin.(6)In this group of 39 patients,22 patients were treated with midazolam alone,and 14 patients were treated with midazolam combined with propofol.Analyzing these two subgroups we know that the combination of midazolam alone was superior.Because the effect of using midazolam alone is not good,we choose to use it in combination with propofol,that is to say,the combination group is so difficult to control that it seems to be less effective than the midazolam group alone.(7)Reasons for discharge: 9cases were abandoned,7 cases discharged after remission,22 cases discharged stably,and 1 case died in the hospital.(8)Prognosis: 2 patients(2/39,5%)were lost to follow-up,11 patients(11/39,28%)died in and out of hospital,and 26 patients(26/39,67%)survived.Of the 26 patients surviving,3 patients had severe neurological dysfunction,4 had mild neurological dysfunction,and the remaining 19 patients had no significant neurological dysfunction.Conclusion:1.The incidence of young and middle-aged SRSE is higher than that of the elderly.2.Viral encephalitis is the most common among acute etiology.Epilepsy is the most common among chronic etiology.The most common cause of chronic etiology is anti-epileptic drugs.The prognosis of acute and chronic etiology make no difference.3.The most common type of seizure in adult with SRSE is SGTSE,followed by SGTSE combined with NCSE with coma.4.The mortality rate of SRSE is high,but more than half(54%)of patients with active treatment have a good prognosis.