Abstract：
BACKGROUND: In 2015, the International League Against Epilepsy proposed a new conceptual definition of status epilepticus (SE) with two operational dimensions (t1 and t2) to guide emergency treatment. The purpose of this study was to compare clinical characteristics and prognoses of patients at these two different time points.
METHODS: We conducted a prospective observational cohort study of consecutive adults diagnosed with SE. In case of convulsive SE, t1 is 5 min and t2 is 30 min, whereas in case of focal SE with impaired consciousness, t1 is 10 min, t2 is 60 min. Data on clinical characteristics, including age, gender, history of prior seizures, neuroimaging, semiology, duration, and etiology of SE, were collected. The primary outcome was mortality, with seizure recurrence as a secondary measure, and functional status as tertiary outcome of enrolled patients at 3 months after SE onset.
RESULTS: We screened one hundred patients with SE, with a median age of 66 years and 61% were male. Fifty-six (56.0%) patients reached t1 of SE, while 44 (44.0%) reached t2 of SE. Convulsive SE (52.0%, n = 52) was more common than focal SE with impaired consciousness (48.0%, n = 48). Status epilepticus secondary to an acute symptomatic process was the most common (50%, n = 50). Patients meeting t2 of SE demonstrated a remarkably increased risk of mortality (unadjusted analysis-RR 3.606, 95%CI 1.552-8.376, p = 0.003; adjusted analysis-RR 2.924, 95%CI 1.221-7.003, p = 0.016) and unfavorable functional status (unadjusted analysis-RR 1.803, 95%CI 1.280-2.539, p = 0.001; adjusted analysis-RR 1.664, 95%CI 1.184-2.340, p = 0.003) at 3 months compared to those who only reached t1 of SE. Patients reaching t2 of SE were more likely to experience seizure recurrence, however, there was no significant difference between the two cohorts.
CONCLUSIONS: Our study provides strong support for the new definition of SE. Patients meeting t2 of SE tend to have a remarkably increased risk of mortality and unfavorable functional outcomes compared to those who only reached t1 of SE. Furthermore, patients were likely to experience seizure recurrence after undergoing an episode of SE. Physicians must be educated about prompt recognition and appropriate management of SE.
METHODS: We conducted a prospective observational cohort study of consecutive adults diagnosed with SE. In case of convulsive SE, t1 is 5 min and t2 is 30 min, whereas in case of focal SE with impaired consciousness, t1 is 10 min, t2 is 60 min. Data on clinical characteristics, including age, gender, history of prior seizures, neuroimaging, semiology, duration, and etiology of SE, were collected. The primary outcome was mortality, with seizure recurrence as a secondary measure, and functional status as tertiary outcome of enrolled patients at 3 months after SE onset.
RESULTS: We screened one hundred patients with SE, with a median age of 66 years and 61% were male. Fifty-six (56.0%) patients reached t1 of SE, while 44 (44.0%) reached t2 of SE. Convulsive SE (52.0%, n = 52) was more common than focal SE with impaired consciousness (48.0%, n = 48). Status epilepticus secondary to an acute symptomatic process was the most common (50%, n = 50). Patients meeting t2 of SE demonstrated a remarkably increased risk of mortality (unadjusted analysis-RR 3.606, 95%CI 1.552-8.376, p = 0.003; adjusted analysis-RR 2.924, 95%CI 1.221-7.003, p = 0.016) and unfavorable functional status (unadjusted analysis-RR 1.803, 95%CI 1.280-2.539, p = 0.001; adjusted analysis-RR 1.664, 95%CI 1.184-2.340, p = 0.003) at 3 months compared to those who only reached t1 of SE. Patients reaching t2 of SE were more likely to experience seizure recurrence, however, there was no significant difference between the two cohorts.
CONCLUSIONS: Our study provides strong support for the new definition of SE. Patients meeting t2 of SE tend to have a remarkably increased risk of mortality and unfavorable functional outcomes compared to those who only reached t1 of SE. Furthermore, patients were likely to experience seizure recurrence after undergoing an episode of SE. Physicians must be educated about prompt recognition and appropriate management of SE.
摘要：
背景：2015年，国际抗癫痫联盟提出了癫痫持续状态（SE）的新概念定义，具有两个操作维度（t1和t2），以指导急诊治疗。这项研究的目的是比较这两个不同时间点患者的临床特征和预后。
方法：我们对连续诊断为SE的成年人进行了一项前瞻性观察性队列研究。如果出现惊厥性SE,t1为5分钟，t2为30分钟，而在意识受损的局灶性SE的情况下，t1为10分钟，t2是60min。临床特征数据，包括年龄,性别,既往癫痫发作史,神经影像学,符号学，持续时间,和SE的病因，被收集。主要结果是死亡率，以癫痫复发为次要指标，和功能状态作为SE发作后3个月纳入患者的三级结局。
结果：我们筛选了100名SE患者，平均年龄66岁，61%为男性。56名(56.0%)患者达到SE的t1，44(44.0%)达到SE的t2。惊厥性SE（52.0%，n=52)比意识受损的局灶性SE更常见(48.0%，n=48）。继发于急性症状过程的癫痫持续状态是最常见的（50％，n=50)。符合SEt2的患者显示死亡风险显着增加（未调整分析-RR3.606，95CI1.552-8.376，p=0.003；调整分析-RR2.924，95CI1.221-7.003，p=0.016）和不利的功能状态（未调整分析-RR1.803，95CI1.280-2.539，p=0.001；调整分析-RR1.1.664，95CI1.184-2.340，达到SEt2的患者更有可能出现癫痫发作复发，然而,两组之间没有显著差异.
结论：我们的研究为SE的新定义提供了有力的支持。与仅达到SE的t1的患者相比，达到SE的t2的患者往往具有显着增加的死亡风险和不利的功能结果。此外，患者在经历SE发作后可能出现癫痫发作复发.必须对医生进行有关SE的及时识别和适当管理的教育。
方法：我们对连续诊断为SE的成年人进行了一项前瞻性观察性队列研究。如果出现惊厥性SE,t1为5分钟，t2为30分钟，而在意识受损的局灶性SE的情况下，t1为10分钟，t2是60min。临床特征数据，包括年龄,性别,既往癫痫发作史,神经影像学,符号学，持续时间,和SE的病因，被收集。主要结果是死亡率，以癫痫复发为次要指标，和功能状态作为SE发作后3个月纳入患者的三级结局。
结果：我们筛选了100名SE患者，平均年龄66岁，61%为男性。56名(56.0%)患者达到SE的t1，44(44.0%)达到SE的t2。惊厥性SE（52.0%，n=52)比意识受损的局灶性SE更常见(48.0%，n=48）。继发于急性症状过程的癫痫持续状态是最常见的（50％，n=50)。符合SEt2的患者显示死亡风险显着增加（未调整分析-RR3.606，95CI1.552-8.376，p=0.003；调整分析-RR2.924，95CI1.221-7.003，p=0.016）和不利的功能状态（未调整分析-RR1.803，95CI1.280-2.539，p=0.001；调整分析-RR1.1.664，95CI1.184-2.340，达到SEt2的患者更有可能出现癫痫发作复发，然而,两组之间没有显著差异.
结论：我们的研究为SE的新定义提供了有力的支持。与仅达到SE的t1的患者相比，达到SE的t2的患者往往具有显着增加的死亡风险和不利的功能结果。此外，患者在经历SE发作后可能出现癫痫发作复发.必须对医生进行有关SE的及时识别和适当管理的教育。
