M. Dhoisne , A. Delval , D. Mathieu , A. Mazeraud , L. Bournisien , P. Derambure , R. Tortuyaux
{"title":"镇静状态下全身抽搐性癫痫的发作复发：其预测因素及其对预后的影响是什么？","authors":"M. Dhoisne , A. Delval , D. Mathieu , A. Mazeraud , L. Bournisien , P. Derambure , R. Tortuyaux","doi":"10.1016/j.neurol.2023.09.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome.</p></div><div><h3>Objective</h3><p>To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV).</p></div><div><h3>Methods</h3><p>We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24<!--> <!-->hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors.</p></div><div><h3>Results</h3><p>Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days.</p></div><div><h3>Conclusions</h3><p>Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.</p></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"180 6","pages":"Pages 507-516"},"PeriodicalIF":2.8000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Seizure recurrences in generalized convulsive status epilepticus under sedation: What are its predictors and its impact on outcome?\",\"authors\":\"M. Dhoisne , A. Delval , D. Mathieu , A. Mazeraud , L. Bournisien , P. Derambure , R. Tortuyaux\",\"doi\":\"10.1016/j.neurol.2023.09.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome.</p></div><div><h3>Objective</h3><p>To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV).</p></div><div><h3>Methods</h3><p>We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24<!--> <!-->hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors.</p></div><div><h3>Results</h3><p>Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days.</p></div><div><h3>Conclusions</h3><p>Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.</p></div>\",\"PeriodicalId\":21321,\"journal\":{\"name\":\"Revue neurologique\",\"volume\":\"180 6\",\"pages\":\"Pages 507-516\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revue neurologique\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0035378723011128\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revue neurologique","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0035378723011128","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：癫痫状态（SE）的治疗重点在于尽早终止发作。难治性 SE 是 SE 患者镇静的指征，但多达 75% 的患者可能因神经或呼吸衰竭而需要通气。对于需要使用镇静剂的患者，临床评估不足以评估癫痫发作的控制情况。识别有复发风险的患者有助于调整对他们的管理。另一方面，低风险患者可受益于尽早撤除镇静剂，以避免不适当的镇静剂对预后产生影响：目的：确定需要机械通气（MV）的全身惊厥性 SE（GCSE）患者中未控制 SE 的发生率、预测因素及其对预后的影响：我们回顾性地纳入了重症监护病房收治的需要机械通气的全身抽搐性休克（GCSE）患者。无法控制的 SE 被定义为镇静期间或停药后 24 小时内的持续或反复发作。采用多变量逻辑回归模型评估相关因素：220例患者中有37例（17%）出现了无法控制的癫痫发作。入院时癫痫持续发作、SAPS II较高和中枢神经系统感染与SE失控风险较高有关。急性中毒或代谢性病因与 SE 不受控制的风险降低有关。在一项补充分析中，白蛋白血药浓度下降与 SE 不受控制有关。未控制的SE与功能预后差和90天后的死亡率有关：结论：在需要进行 MV 的 GCSE 患者中，17% 患有未受控制的 SE。病因和入院时癫痫持续发作是预测 SE 不受控制的主要因素。SE 不受控制的患者镇静和 MV 持续时间较长，功能预后较差，死亡率较高。需要进一步研究确定持续脑电图监测对临床过程的影响。
Seizure recurrences in generalized convulsive status epilepticus under sedation: What are its predictors and its impact on outcome?
Background
Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome.
Objective
To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV).
Methods
We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24 hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors.
Results
Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days.
Conclusions
Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.
期刊介绍：
The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899.
The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations.
The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
