Clinical, etiological profile and outcomes of convulsive refractory and non-refractory status epilepticus at a tertiary care centre: A prospective observational study
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引用次数: 1
Abstract
Introduction: Epidemiological data on childhood status epilepticus (SE) limited in India. This study depicts clinical profiles, etiology, and outcomes of convulsive refractory SE (RSE) and compares the results with cases of nonrefractory SE (NRSE). Subjects and Methods: This observational, cross-sectional study enrolled 300 children aged 1 month to 18 years, presenting with convulsive SE at a tertiary care hospital. Details of children who progressed to RSE were compared to those without RSE. Results: In the acute symptomatic etiology group, common causes for RSE were central nervous system infections (33.8%), cryptogenic etiology (13.8%), and remote symptomatic etiology (7%). RSE iwas associated with a higher rate of complications (58% Vs 24%) as compared to NRSE. Thirty percent of cases that progressed to RSE needed ventilator support as compared to only 8% of cases in the NRSE group. RSE was also associated with higher rates of shock (25%), AKI (16%), transaminitis (25%), acute liver failure (5.69%), multiple organ dysfunction score (12.6%), and acidosis (53%) as compared to NRSE. RSE was associated with higher mortality (28%) and morbidity (32%) as compared to NRSE cases. Cryptogenic etiology led to the highest mortality (33.3%) in cases of RSE while acute symptomology was associated with the highest morbidity (62%). Conclusions: RSE is a serious pediatric emergency that requires prompt recognition and management. Clinical knowledge and early administration of appropriate antiepileptic drugs at health-care facilities is the key to reduce morbidity and mortality.
引言:印度儿童癫痫持续状态(SE)的流行病学数据。本研究描述了惊厥性难治性SE (RSE)的临床特征、病因和结局,并将结果与非难治性SE (NRSE)进行了比较。对象和方法:这项观察性横断面研究纳入了300名1个月至18岁的儿童,在三级保健医院出现惊厥性SE。将进展为RSE的儿童的细节与未进展为RSE的儿童进行比较。结果:急性症状组RSE的常见病因为中枢神经系统感染(33.8%)、隐源性病因(13.8%)和远端症状病因(7%)。与NRSE相比,RSE与更高的并发症发生率相关(58% Vs 24%)。30%进展为RSE的病例需要呼吸机支持,而NRSE组只有8%的病例需要。与NRSE相比,RSE还与较高的休克(25%)、AKI(16%)、转氨炎(25%)、急性肝衰竭(5.69%)、多器官功能障碍评分(12.6%)和酸中毒(53%)发生率相关。与NRSE病例相比,RSE与更高的死亡率(28%)和发病率(32%)相关。在RSE病例中,隐源性病因导致的死亡率最高(33.3%),而急性症状导致的发病率最高(62%)。结论:RSE是一种严重的儿科急症,需要及时认识和处理。临床知识和在卫生保健机构早期使用适当的抗癫痫药物是降低发病率和死亡率的关键。