Abstract：
To investigate the initial treatment of patients with convulsive status epilepticus (CSE) in a resource-limited region of China, and to discuss the difference of in-hospital outcomes and economic costs between those with guideline-recommended initial treatment and those without.
In this retrospective study, we screened adult patients discharged with the diagnosis of CSE in four centers in west China. Individuals with different exposure to the initial drug were divided into benzodiazepine (BDZ) and non-BDZ group for outcome comparison. The primary outcomes were seizure control, and the ratio of patients who developed refractory SE. The secondary outcomes included in-hospital mortality, the modified Rankin Scale (mRS) score at discharge, in-hospital respiratory support rate, length, and cost of the stay.
Three-hundred and thirteen patients (127, 40.6% were women) with CSE were included. The median age was 43 (range 16-92). There were 152 (48.6%) patients initially treated with BDZ. Among the 36 who received midazolam as initial treatment, twenty-six received an insufficient dose. The other 116 (76.3%) patients in the BDZ group chose diazepam as initial treatment. Fifteen of them (12.9%) were treated underdose. In the non-BDZ group (161, 51.4%), antiseizure medications (ASMs) and/or coma-induced drugs were used as initial treatment. Among those initially administrated ASMs, intramuscular phenobarbital (38,37.6%) and valproate (46, 52.3%) were most frequently seen. There was a significant difference in the time latency to initial treatment and etiology between BDZ and non-BDZ group. The non-BDZ group reported a higher cessation rate after initial treatment compared to the BDZ group (P = 0.012). No significant difference in other primary and secondary outcomes.
Non-adherence and underdosing of the initial treatment of SE were common in China. However, the non-BDZ group showed a better seizure control rate. The effect came from early aggressive medication, that is, the combination of ASMs and anesthesia. Non-BDZ group was not inferior to BDZs in terms of seizure control, the occurrence of in-hospital death, and poor outcome at discharge. More robust evidence is needed in developing settings when choosing the initial treatment.
In this retrospective study, we screened adult patients discharged with the diagnosis of CSE in four centers in west China. Individuals with different exposure to the initial drug were divided into benzodiazepine (BDZ) and non-BDZ group for outcome comparison. The primary outcomes were seizure control, and the ratio of patients who developed refractory SE. The secondary outcomes included in-hospital mortality, the modified Rankin Scale (mRS) score at discharge, in-hospital respiratory support rate, length, and cost of the stay.
Three-hundred and thirteen patients (127, 40.6% were women) with CSE were included. The median age was 43 (range 16-92). There were 152 (48.6%) patients initially treated with BDZ. Among the 36 who received midazolam as initial treatment, twenty-six received an insufficient dose. The other 116 (76.3%) patients in the BDZ group chose diazepam as initial treatment. Fifteen of them (12.9%) were treated underdose. In the non-BDZ group (161, 51.4%), antiseizure medications (ASMs) and/or coma-induced drugs were used as initial treatment. Among those initially administrated ASMs, intramuscular phenobarbital (38,37.6%) and valproate (46, 52.3%) were most frequently seen. There was a significant difference in the time latency to initial treatment and etiology between BDZ and non-BDZ group. The non-BDZ group reported a higher cessation rate after initial treatment compared to the BDZ group (P = 0.012). No significant difference in other primary and secondary outcomes.
Non-adherence and underdosing of the initial treatment of SE were common in China. However, the non-BDZ group showed a better seizure control rate. The effect came from early aggressive medication, that is, the combination of ASMs and anesthesia. Non-BDZ group was not inferior to BDZs in terms of seizure control, the occurrence of in-hospital death, and poor outcome at discharge. More robust evidence is needed in developing settings when choosing the initial treatment.
摘要：
目的：探讨中国资源有限地区惊厥性癫痫持续状态（CSE）患者的初始治疗方法。并讨论接受指南推荐初始治疗的患者与未接受指南推荐初始治疗的患者之间的住院结局和经济成本差异.
方法：在这项回顾性研究中，我们在中国西部的四个中心筛选了诊断为CSE的成年出院患者。将不同暴露于初始药物的个体分为苯二氮卓（BDZ）和非BDZ组，以进行结果比较。主要结果是癫痫发作控制，以及出现难治性SE的患者比例。次要结果包括院内死亡率，出院时改良Rankin量表（mRS）评分，院内呼吸支持率，长度,和住宿的费用。
结果：纳入了13例CSE患者（127例，40.6%为女性）。中位年龄为43（范围16-92）。有152名(48.6%)患者最初接受BDZ治疗。在接受咪达唑仑作为初始治疗的36人中，二十六人接受的剂量不足。BDZ组的其他116例（76.3％）患者选择地西泮作为初始治疗。其中15例（12.9%）治疗剂量不足。在非BDZ组中（161，51.4%），抗癫痫药物(ASM)和/或昏迷诱导药物被用作初始治疗.在最初管理的ASM中，最常见的是肌内苯巴比妥（38,37.6％）和丙戊酸盐（46,52.3％）。BDZ组和非BDZ组之间在初始治疗的潜伏期和病因方面存在显着差异。与BDZ组相比，非BDZ组报告的初始治疗后停止率更高（P=0.012）。其他主要和次要结果无显著差异。
结论：SE初始治疗的不依从性和剂量不足在中国很常见。然而,非BDZ组癫痫发作控制率较好。效果来自早期的积极药物治疗，也就是说,ASM和麻醉的组合。非BDZ组在癫痫发作控制方面不逊于BDZ，医院内死亡的发生，出院时结果不佳。在选择初始治疗时，在开发环境中需要更有力的证据。
方法：在这项回顾性研究中，我们在中国西部的四个中心筛选了诊断为CSE的成年出院患者。将不同暴露于初始药物的个体分为苯二氮卓（BDZ）和非BDZ组，以进行结果比较。主要结果是癫痫发作控制，以及出现难治性SE的患者比例。次要结果包括院内死亡率，出院时改良Rankin量表（mRS）评分，院内呼吸支持率，长度,和住宿的费用。
结果：纳入了13例CSE患者（127例，40.6%为女性）。中位年龄为43（范围16-92）。有152名(48.6%)患者最初接受BDZ治疗。在接受咪达唑仑作为初始治疗的36人中，二十六人接受的剂量不足。BDZ组的其他116例（76.3％）患者选择地西泮作为初始治疗。其中15例（12.9%）治疗剂量不足。在非BDZ组中（161，51.4%），抗癫痫药物(ASM)和/或昏迷诱导药物被用作初始治疗.在最初管理的ASM中，最常见的是肌内苯巴比妥（38,37.6％）和丙戊酸盐（46,52.3％）。BDZ组和非BDZ组之间在初始治疗的潜伏期和病因方面存在显着差异。与BDZ组相比，非BDZ组报告的初始治疗后停止率更高（P=0.012）。其他主要和次要结果无显著差异。
结论：SE初始治疗的不依从性和剂量不足在中国很常见。然而,非BDZ组癫痫发作控制率较好。效果来自早期的积极药物治疗，也就是说,ASM和麻醉的组合。非BDZ组在癫痫发作控制方面不逊于BDZ，医院内死亡的发生，出院时结果不佳。在选择初始治疗时，在开发环境中需要更有力的证据。
