RT杂志文章SR电子T1比较重症监护室孤立性癫痫发作和癫痫持续状态:一项观察性队列研究JF神经病学JO神经病学FD Lippincott Williams & Wilkins SP 10.1212/WNL.0000000000206838半岛投注体育官网10.1212 / WNL.0000000000206838A1 Wagner, Anna S A1 Baumann, Sira M A1 Semmlack, Saskia A1 Frei, Anja I A1 Rüegg, Stephan A1 Hunziker, Sabina A1 Marsch, Stephan A1 Sutter, Raoul YR 2023 UL http://n.半岛投注体育官网neurology.org/content/early/2023/03/06/WNL.0000000000206838.abstract AB目的:评估癫痫发作危重成人患者中癫痫持续状态(SE)的频率，并确定重症监护病房(ICU)中孤立性癫痫发作患者与SE患者之间的临床差异。方法:从2015年到2020年，通过筛查所有数字医疗、ICU和脑电图记录，确定了瑞士三级护理中心所有重症监护医师和/或咨询神经科医生报告的孤立性癫痫或SE的连续成年ICU患者。排除<18岁和缺氧缺血性脑病所致肌阵挛但脑电图无癫痫发作的患者。孤立性癫痫发作和SE的频率以及与SE相关的癫痫发作时的临床特征是主要结局。进行单变量和多变量逻辑回归以确定与SE出现的关联。结果:404例癫痫发作患者中，51%为SE。与单纯癫痫发作患者相比，SE患者Charlson共病指数(CCI)中位数更低(3比5,p<0.001)，致死性病因更少(43.6%比80.5%，p<0.001)，格拉斯哥昏迷评分中位数更高(7比5,p<0.001)，发烧频率更高(27.5%比7.5%，p<0.001)， ICU和住院时间中位数更短(ICU: 4比5天，p=0.039;住院时间:13天比15天，p=0.045)，且更常恢复到发病前功能(36.8%比17%，p<0.001)。多变量分析显示，SE的优势比(OR)随着CCI (OR=0.91, 95%可信区间[CI] 0.83-0.99)、致死病因(OR=0.15, 95%CI 0.08-0.29)和癫痫(OR=0.32, 95%CI 0.16-0.63)的增加而降低。在排除以癫痫作为ICU入院原因的患者后，全身炎症与SE存在额外的相关性(ORfor CRP=1.01, 95%CI 1.00-1.01; ORfor fever=7.35, 95%CI). While fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy.Conclusions: Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention.

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