摘要
目的分析成人全面惊厥性癫痫持续状态（generalizedconvulsivestatusepilepticus，GCSE）患者初始静脉输注抗癫痫药物（antiepilepticdrugs，AEDs）治疗失败的临床与持续脑电图（continuouselectroencephalography，cEEG）监测数据，以便制订更加合理的GCSE治疗方案。方法汇总2007--2012年先后2个随机对照试验患者的相关数据。将患者分为完全控制和癫痫复发两组，进行比较。记录GCSE患者初始治疗后6h内癫痫复发率、cEEG模式及AEDs血药浓度。结果癫痫复发组病因、治疗前GCSE持续时间、cEEG模式均与完全控制组存在差异，进一步将3个因素引入多因素Logistic回归方程：仅发作间期癫痫性放电（interictalepileptiformdischarges，IEDs）和周期性放电（periodicepilepticdischarges，PEDs）和（或）非惊厥性发作持续状态（non—convulsivestatusepilepticus，NCSE）模式与癫痫复发独立相关（分别为OR=5．486，95％C／1．708～17．621；OR=21．056，95％C／3．653～121．371，均P〈0．05），而病毒性脑炎（OR=10．433，95％C／3．223～33．769，P〈0．05）和GCSE持续时间〉4h（OR=5．381，95％C／1．918～15．096，P〈0．05）又与IEDs模式和PEDs和（或）NCSE模式独立相关。结论GCSE患者经静脉输注AEDs后须进行cEEG监测，并应成为临床医生判断癫痫是否完全终止的重要手段。临床医生应根据这些相关因素对抗癫痫治疗方案进行个体化调整，以减少癫痫复发。
Objective To analyze the clinical and electroencephalography （EEG） data associated with failure of adult generalized convulsive status epilepticus （GCSE） patients after initial treatment and to establish more reasonable strategies for GCSE patients. Methods Patients divided into 2 groups （full control group and seizure relapse group） were derived from emergency department and neuro-intensive care unit （NICU） of Xuanwu Hospital from 2007 to 2012. Pooled data originated from 2 randomized controlled trials were collected. Seizure relapse rate, continuous electroencephalography （cEEG） patterns and antiepileptic drugs （AEDs） plasma concentrations were analyzed after 6 h of GCSE initial treatment. Results There were statistically differences between seizure relapse group and full control group for etiology, GCSE duration before treatment and EEG patterns. By further multi-factor logistic regression, interictal epileptiform discharges （IEDs） and periodic epileptic discharges and （or） non-con vulsive status epilepticus （PEDs/NCSE） patterns were associated with seizure relapse independently （OR = 5.486, 95% CI 1. 708-- 17. 621 ; OR = 21. 056,95% CI 3. 653--121. 371, P 〈 0. 05 respectively） and that viral encephalitis and GCSE duration （ 〉 4 h） were associated with IEDs and PEDs/NCSE patterns independently （ OR -- 10. 433, 95% CI 3. 223--33. 769 ; OR = 5. 381,95% CI 1. 918--15. 096 respectively）. Conclusions It is a crucial method for clinicians to judge seizure termination by EEG after initially intravenous AEDs treatment for GCSE patients. Clinicians should individualize anti-epileptic strategies according to these factors so as to avoid of seizure relapse.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2013年第8期508-512,共5页
Chinese Journal of Neurology
基金
基金项目：首都临床应用特色项目资助项目（Z111107058811010）
国家临床重点专科建设项目经费资助项目
关键词
癫痫持续状态
抗惊厥药
治疗失败
脑电描记术
Status epilepticus
Anticonvulsants
Treatment failure
Electroencephalography
