Purpose

The objective of the study was to evaluate the frequency, clinical, and video-electroencephalographic (VEEG) predictors of convlusive status epilepticus (CSE) in the epilepsy-monitoring unit (EMU).

Methods

The data of all patients who had CSE in our EMU between 2008 and 2017 were reviewed. For each case, two age- and diagnosis-matched subjects who underwent VEEG and did not develop CSE were taken as internal controls. Electro-clinical data of both the groups were compared. Predictors of CSE were assessed using logistic regression analysis.

Results

Out of 11,188 video-telemetries were conducted between 2008-17, forty-three events of CSE (0.38%) were recorded. On comparisons with 86 internal controls no differences were apparent on prevalence of cognitive impairment, structural lesion, number of baseline anti-seizure medications (ASM), ASM taper schedule, ictal patterns, and duration of VEEG monitoring. Inter-ictal rhythmic periodic patterns had significantly higher prevalence in cases (p = 0.028). Logistic regression analysis revealed that odds of CSE were higher with past history of SE [p = 0.008; adjusted odds ratio (OR) = 5.48 (confidence intervals {CI} 1.55–19.28)] and in presence of rhythmic spike and wave discharges [p = 0.016, OR = 33.518(CI = 1.93–581.4)]; the odds were lower if the first two seizures recorded did not evolve into CSE [p = 0.009, OR = 0.247 (CI = 0.08–0.70)] and if there was prior history of daily seizures [p = 0.02, OR = 0.250 (CI = 0.07–0.84)].

Conclusion

CSE is a rare yet important adverse event in EMU. Clinical predictors are more relevant in comparison to EEG variables. Extent of ASM withdrawal may not directly account for occurrence of CSE; factors inherent to a patient’s epilepsy are deterministic.

中文翻译：

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可以预测视频遥测期间发生惊厥性癫痫持续状态吗？癫痫监测单位的观察结果

目的

该研究的目的是评估癫痫监测单元 (EMU) 中癫痫持续状态 (CSE) 的频率、临床和视频脑电图 (VEEG) 预测因子。

方法

回顾了 2008 年至 2017 年间在我们的 EMU 中患有 CSE 的所有患者的数据。对于每个病例，将接受 VEEG 且未发生 CSE 的两名年龄和诊断匹配的受试者作为内部对照。比较两组的电临床数据。使用逻辑回归分析评估 CSE 的预测因子。

结果

在 2008-17 年间进行的 11,188 次视频遥测中，记录了 43 次 CSE (0.38%) 事件。与 86 名内部对照相比，在认知障碍的患病率、结构性病变、基线抗癫痫药物 (ASM) 的数量、ASM 逐渐减量计划、发作模式和 VEEG 监测持续时间方面没有明显差异。发作间节律周期模式在病例中的患病率显着更高（p  = 0.028）。Logistic 回归分析显示，过去有 SE 病史的 CSE 几率更高 [ p  = 0.008; 调整优势比 (OR) = 5.48（置信区间 {CI} 1.55–19.28）] 并且存在节律性尖峰和波放电 [ p = 0.016，OR = 33.518（CI = 1.93–581.4）]；如果记录的前两次癫痫发作没有演变成 CSE [ p  = 0.009, OR = 0.247 (CI = 0.08–0.70)] 并且如果有每日癫痫发作的既往史 [ p  = 0.02, OR = 0.250 (CI = 0.07–0.84)]。

结论

CSE 是 EMU 中罕见但重要的不良事件。与 EEG 变量相比，临床预测因子更相关。ASM 退出的程度可能无法直接解释 CSE 的发生；患者癫痫的固有因素​​是确定性的。