Aetiology of convulsive status epilepticus in adults_West China Medical Journal

Authors：

ZHANG Jie ^1,2 , GUO Yonghua ^1,3 , ZHOU Dong ¹ ,  HONG Zhen ¹

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurology, First People’s Hospital of Longquanyi District, Chengdu, Sichuan 610100, P. R. China;
3. Department of Neurology, the People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

HONG Zhen, Email: hongzhengoog@aliyun.com

Keywords：

Aetiology; Epilepticus; Status epilepticus

DOI：

10.7507/1002-0179.201811045

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Objective To investigate the etiology of patients with convulsive status epilepticus (CSE).Methods By 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.Results In 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).Conclusions Cerebrovascular diseases are the leading causes of geriatric CSE. Irregular medication of epilepsy patients is a prominent avoidable trigger for CSE.

Citation： ZHANG Jie, GUO Yonghua, ZHOU Dong, HONG Zhen. Aetiology of convulsive status epilepticus in adults. West China Medical Journal, 2019, 34(4): 400-404. doi: 10.7507/1002-0179.201811045 Copy

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2.	Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care, 2012, 17(1): 3-23.
3.	DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology, 1996, 46(4): 1029-1035.
4.	Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology, 1998, 50(3): 735-741.
5.	Li JM, Chen L, Zhou B, et al. Convulsive status epilepticus in adults and adolescents of Southwest China: mortality, etiology, and predictors of death. Epilepsy Behav, 2009, 14(1): 146-149.
6.	Zhou B, Huang Y, Wang J, et al. The aetiology of convulsive status epilepticus: a study of 258 cases in Western China. Seizure, 2014, 23(9): 717-721.
7.	Engel J Jr. Report of the ILAE classification core group. Epilepsia, 2006, 47(9): 1558-1568.
8.	National Clinical Guideline Centre. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care: pharmacological update of clinical guideline 20. London: Royal College of Physicians (UK) , 2012.
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10.	Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA, 1993, 270(7): 854-859.
11.	Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol, 2004, 11(12): 800-810.
12.	Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia, 2001, 42(6): 714-718.
13.	DeLorenzo RJ, Pellock JM, Towne AR, et al. Epidemiology of status epilepticus. J Clin Neurophysiol, 1995, 12(4): 316-325.
14.	Hui AC, Joynt GM, Li H, et al. Status epilepticus in Hong Kong Chinese: aetiology, outcome and predictors of death and morbidity. Seizure, 2003, 12(7): 478-482.
15.	Phabphal K, Geater A, Limapichart K, et al. Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from Southern Thailand. Epileptic Disord, 2013, 15(3): 255-261.
16.	King EJ, Ferrie CD, Livingston JH, et al. Recovery of consciousness following acute symptomatic seizures due to central nervous system infections in children. Dev Med Child Neurol, 2012, 54(4): 324-327.
17.	Murthy JM, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia, 2007, 48(12): 2217-2223.
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21.	Strzelczyk A, Zöllner JP, Willems LM, et al. 拉科酰胺在癫痫持续状态中的应用—针对现有证据的系统评价. 肖英凤, 译, 童馨, 慕洁, 审. 癫痫杂志, 2018, 4(5): 446-460.

1. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol, 2015, 14(6): 615-624.
2. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care, 2012, 17(1): 3-23.
3. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology, 1996, 46(4): 1029-1035.
4. Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology, 1998, 50(3): 735-741.
5. Li JM, Chen L, Zhou B, et al. Convulsive status epilepticus in adults and adolescents of Southwest China: mortality, etiology, and predictors of death. Epilepsy Behav, 2009, 14(1): 146-149.
6. Zhou B, Huang Y, Wang J, et al. The aetiology of convulsive status epilepticus: a study of 258 cases in Western China. Seizure, 2014, 23(9): 717-721.
7. Engel J Jr. Report of the ILAE classification core group. Epilepsia, 2006, 47(9): 1558-1568.
8. National Clinical Guideline Centre. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care: pharmacological update of clinical guideline 20. London: Royal College of Physicians (UK) , 2012.
9. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--report of the ILAE task force on classification of status epilepticus. Epilepsia, 2015, 56(10): 1515-1523.
10. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA, 1993, 270(7): 854-859.
11. Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol, 2004, 11(12): 800-810.
12. Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia, 2001, 42(6): 714-718.
13. DeLorenzo RJ, Pellock JM, Towne AR, et al. Epidemiology of status epilepticus. J Clin Neurophysiol, 1995, 12(4): 316-325.
14. Hui AC, Joynt GM, Li H, et al. Status epilepticus in Hong Kong Chinese: aetiology, outcome and predictors of death and morbidity. Seizure, 2003, 12(7): 478-482.
15. Phabphal K, Geater A, Limapichart K, et al. Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from Southern Thailand. Epileptic Disord, 2013, 15(3): 255-261.
16. King EJ, Ferrie CD, Livingston JH, et al. Recovery of consciousness following acute symptomatic seizures due to central nervous system infections in children. Dev Med Child Neurol, 2012, 54(4): 324-327.
17. Murthy JM, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia, 2007, 48(12): 2217-2223.
18. Legriel S, Mourvillier B, Bele N, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med, 2008, 34(3): 476-480.
19. 陈贺. 中国交通事故死亡状况及酒驾处罚对交通事故死亡率的影响. 北京: 中国疾病预防控制中心, 2017.
20. Rossetti AO, Logroscino G. Re: in-hospital mortality of generalized convulsive status epilepticus: a large US sample. Neurology, 2008, 70(20): 1939.
21. Strzelczyk A, Zöllner JP, Willems LM, et al. 拉科酰胺在癫痫持续状态中的应用—针对现有证据的系统评价. 肖英凤, 译, 童馨, 慕洁, 审. 癫痫杂志, 2018, 4(5): 446-460.

West China Medical Journal

Aetiology of convulsive status epilepticus in adults

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