Objectives Retrospective analysis of the Tibetan convulsive status epilepticus (CSE) for the aetiology, prognosis and its influencing factors in Tibet area. Methods Through electronic patient record, making “epilepsy”, “status epilepticus ”, “epileptic seizure” as keywords, convulsive status epilepticus patients in the People’s Hospital of Tibet Autonomous Region hospitalized from January 2015 to December 2020 were retrospectively observed, gathering their clinical data and aided examinations furthermore, and the prognoses were returned by telephone, meanwhile the functional status of those patients was assessed by the modified rankin scale. and the causes differ in gender, age, out-of-hospital antiepileptic treatment, family history of epilepsy and history of epilepsy were analyzed. The prognostic factors were analyzed by logistic regression. Results A total of 2 254 hospitalized patients with epilepsy were retrieved, including 331 CSE patients aged 14~84 years, 219 males and 112 females. There were 36 lost calls, 62 CSE deaths (21.01%), and 4 adverse outcomes (non-death)(1.7%).There were statistically significant differences in etiology of CSE in different ages and history of epilepsy (P<0.05), but there were no statistically significant differences in gender, out-of-hospital antiepileptic treatment, progression of refractory status epilepticus and family history of epilepsy. Cerebrovascular disease was the main cause of CSE in people aged 45 and over (54 cases), while the main cause of CSE in people aged under 45 was unknown (104 cases).Among the patients with previous history of epilepsy, the highest proportion was unknown cause [117 cases (48.8%)]; Among patients without a history of epilepsy, cerebrovascular disease [34 cases (37.4)] was the most common cause of CSE. Multivariate logistic regression analysis of prognostic factors of CSE showed that gender, age, GCS and electrolyte disorder had statistically significant effects on the death of CSE patients (P<0.05), while altitude and their duration and other factors had no statistically significant effects on the death of CSE patients (P>0.05). ConclusionsCerebrovascular disease is the leading cause of CSE in people aged 45 and over. Male, advanced age, low GCS score at discharge, and electrolyte disorder were risk factors.
Purpose To analyze the clinical characteristicsand prognostic factors of Status epilepticus (SE) in children. Methods The clinical data of 33 children with SE treated in Jinan Central Hospital Affiliated of Shandong University from January 2014 to June 2021 were collected, and their clinical characteristics were analyzed. Then, according to Glasgow prognosis scale, the children were divided into good prognosis group (n=20) and poor prognosis group (n=13). The age of first attack, duration of attack, type of attack and SE classification, EEG, cranial imaging and etiology were used to analyze the influencing factors of SE prognosis. Results 75.7% were 0 ~ 6 years old in the age of first attack, and 29 cases of convulsive status epilepticus accounted for 87.9% in the classification of seizure types. There were significant differences in age of first attack, duration of attack, EEG, history of mental retardation and etiology between the two groups (P<0.05); Logistic regression analysis showed that the age of first attack, duration of attack, history of mental retardation and EEG were independent factors affecting the prognosis. Conclusion Low age, especially ≤ 6 years old, is the high incidence of SE in children at first attack. Most children are symptomatic and have obvious incentives. Convulsive SE is the main type of SE in children. The age of first onset, duration of epilepsy, history of mental retardation, and EEG can affect the prognosis of SE.
ObjectiveTo investigate the etiology, clinical features, treatment, and prognosis of Partial status epilepticus (PSE). MethodsSeventeen PSE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from April 2013 to June 2015. Clinical data were retrospectively analyzed. ResultsA total of 17 patients, 8 male and 9 female, 18~91years old, at mean age (48.90±21.17) years were included. About 12 cases (70.59%) had acute symptomatic status epilepticus, the etiologies including central nervous system inflammation (5 cases), cortical infarction (3 cases), metabolic disorder (1 case), hypoxic-ischemic encephalopathy (1 case), space-occupying lesions(1 case) and degeneration (1 case); four cases (23.53%) were diagnosed with epilepsy, one case (5.88%) had no definite pathogenesis. The seizure types included complex partial status epilepticus (8 cases, 47.06%), complex part of the secondary comprehensive status epilepticus (3 cases, 17.65%), supplementary motor area (SMA) status epilepticus (4 cases, 23.53%), epilepsia partialis continua (EPC) (1case, 5.88%)and complex partial status epilepticus & aura continua (1case, 5.88%). Nine cases (52.94%) were effective after one hour treament, eight cases (47.06%) were negative. 17 cases are followed-up and 4 cases lost, the average follow-up time is (10.89±8.64) months. 8 cases are completely seizure free, and 3 cases have experience less seizures or the symptom is relived; the other 2 cases die from Creutzfeldt-Jacob desease(case No.10) and Respiratory failure(case No.12). ConclusionsThe inpatients of partial status epilepticus are mostly "situation related". Patients with clinical suspect should be administrated with long term video-Electroencephalogram(EEG) monitoring timely. Early diagnosis, treatment and the aggressive treatment can help to improve the prognosis. Patients of encephalitis usually progress into refractory status epilepticus, the anesthetic drugs should be used as soon as possible.
Status epilepticus (SE) is one of the most common neurological emergencies. Prolonged seizures can cause permanent neuronal death in the central nervous system, necessitating early recognition and timely intervention. Although there is some consensus on the diagnosis and treatment of SE, the high heterogeneity of SE patients presents a significant challenge for standardized management and prognosis prediction. This review summarizes the current research progress on the diagnosis, treatment, and prognosis of SE, aiming to provide references for early diagnosis, early treatment, and early prediction of prognosis.
ObjectiveTo observe the dynamic changes of neuroglobin (NGB) expression in hippocampus after status epilepticus(SE) in rats, and to explore the role of NGB in epileptic seizures.Methods40 healthy male Sprague Dawley rats were randomly divided into two group according to random number table method:control group (n=5) and epilepsy model group(n=35).Epilepsy model group according to observation time was divided into:0h, 1h, 3h, 12h, 24h, 10d and 30d.Intraperitoneal injection Lithium-pilocarpine (20 mg/kg~127 mg/kg, Li-PC) to establish the rat model of SE.Observe the behavioral changes in rats with epilepsy.Nissl staining was used to detect the neuronal damage in hippocampus. Streptavidin-biotin-peroxidase complex immunohistochemical method was used to detect the expression level of NGB in hippocampus;ResultsAfter SE, the neurons in hippocampus were severely damaged with the progress of epileptic seizures, the number of surviving neurons in CA1, CA3 regions showed a near linear decline.Among them, the number of surviving neurons in (12h, 24h, 10d, 30d)CA1, (0h, 12h, 24h, 10d, 30d)CA3 and(12h, 24h, 10d, 30d) DG area were significantly lower than that of the control group (P < 0.05).The expression level of NGB in CA1, CA3 and DG region of hippocampus were increased after SE, and both of CA1 and DG were reached peak in 24h after SE, but was still higher than the control group.And the CA3 area showed a continue rising trend.Among them, CA1(24h, 10d, 30d), CA3(24h, 10d, 30d) and DG(12h, 24h, 10d, 30d) were higher than that of control group significantly (P < 0.05).In addition, it was found that there was a positive correlation between the number of surviving neurons in CA3 area and the expression level of NGB (R=0.306, P=0.011).ConclusionUp-regulation of NGB expression in hippocampus after status epilepticus, and was positively correlated with the number of neurons in the CA3 area, suggesting that up regulation of NGB expression may be a compensatory protective mechanism of ischemic injury induced by seizures, and participate in the protection of epilepsy related neuronal damage.
ObjectiveTo explore the dynamic expression changes of neuronal growth and differentiation-associated miR-124a and miR-9 in the process of epileptogenesis. MethodsEstablish the lithium-pilocarpine induced status epilepticus (SE) rat model. Animal behavior change induced by SE as well as in the period of chronic epilepsy was observed by naked-eye or video-recording. Major time points for the study were chosen at 1d, 7d, 14d and 28d post-SE, on which the post-SE rats were decapitated and their hippocampal specimens were obtained. Total RNA from each specimen was extracted and qPCR was exploited to detect miR-124a and miR-9 expression in the specimens. Statistical analysis was used to show the dynamic expressional changes of miR-124a and miR-9 in rat hippocampus at 1d, 7d, 14d and 28d post-SE during the process of epileptogenesis. ResultsCompared with normal rats, the expression level of miR-124a in rat hippocampus did not show a significant difference at 1d post-SE, but it had shown markedly differences at 7d, 14d and 28d post-SE(P < 0.05), with a declining trend. Compared with normal rats, the expression level of miR-9 had demonstrated significant differences at 1d, 7d, 14d and 28d post-SE(P < 0.05)with a generally increasing trend, although there was slight fluctuation of expressional up-regulation at 7d post-SE. ConclusionNeuronal growth and differentiation-associated miR-124a and miR-9 had shown dynamic changes of down-regulation or up-regulation in the process of epileptogenesis. It can be suspected that miR-124a and miR-9 take part in hippocampal neurogenesis post-SE and be involved in epileptogenesis process.
ObjectiveTo investigate the etiology of patients with convulsive status epilepticus (CSE).MethodsBy taking epilepsy, seizure, status epilepticus, and epileptic seizure as keywords, the clinical data of epilepsy patients hospitalized in the First People’s Hospital of Longquanyi District of Chengdu and the People’s Hospital of Leshan from January, 2012 to December, 2017 were retrospectively collected from a retrieval system for electronic patient records. The collected CSE cases were screened by trained epilepsy specialists in strict accordance with inclusion criteria and exclusion criteria. The etiology of CSE, and the pathogenetic distinctions among patients with different ages, sexes, educational levels, places of residence, and histories of epilepsy were analyzed based on medical histories and accessory examinations. The prognostic factors for epilepsy were determined using logistic regression analysis.ResultsIn this study, a total of 852 hospitalized epilepsy cases were retrieved, among which 104 cases were CSE cases aged between 18 and 86, including 75 males and 29 females. There were 13 CSE deaths (12.5%). There were significant differences in the pathogeneses among CSE patients with different ages and histories of epilepsy (χ2=52.396, 18.354; P<0.05). However, no significant difference in CSE pathogeneses was observed among patients with different sexes, educational levels, or places of residence (P>0.05). Drug withdrawal or dose reduction was the leading cause of CSE in patients with a history of epilepsy (n=28, 57.1%), while cerebrovascular diseases (n=19, 34.5%) were common causes among those without a history. Among patients aged over 65, cerebrovascular diseases (n=17, 43.6%) were determined as the major causes of CSE, while for those aged under 65, drug withdrawal or dose reduction was the main pathogeny (n=20, 30.8%). Results obtained from multivariate logistic regression analysis on the prognostic factors for epilepsy showed that the duration of epileptic seizure significantly influenced the prognosis of patients [odds ratio=1.299, 95% confidence interval (1.074, 1.571), P=0.007], while there were no significant correlations between other factors and epilepsy prognosis (P>0.05).ConclusionsCerebrovascular diseases are the leading causes of geriatric CSE. Irregular medication of epilepsy patients is a prominent avoidable trigger for CSE.