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.
The correlation between gut microbes and epilepsy is a hot research topic. This review aims to summarize the effects of Ketogenic diet (KD) on gut microbes and the preclinical and clinical progress of the use of Fecal microbiota transplants (FMT) and Probiotics in the intervention of epilepsy to provide clinical reference. Gut microbes mediates the antiepileptic effect of KD. Many studies have found that bactericides decreased in epileptic patients, and KD can increase bactericides abundance, which may be one of its effective mechanisms. Both FMT and probiotics showed antiepileptic effects on epileptic model mice with different pathogenesis, suggesting that gut microbes is an important target for epilepsy treatment. Preliminary clinical studies of small samples suggest that the use of probiotics can effectively treat refractory epilepsy and autoimmune-associated epilepsy, and can improve comorbidities. No serious and long-term side effects of probiotics have been found in epileptic patients. In the future, more high-quality studies are needed to further clarify its efficacy and mechanisms, which could lead to new strategies for epilepsy treatment and refresh our understanding of the causes of epilepsy.
ObjectiveTo analyze the diagnosis status and epidemiological characteristics of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis) in the Sichuan province of China. MethodsIn the retrospective survey study, data of cases suspected as autoimmune encephalitis in Sichuan province from January 2012 to February 2017 were collected from the third-party test center.The diagnosis status and epidemiological characteristics of anti-NMDAR encephalitis were analyzed. Results① A total of 1 714 cases had been suspected as autoimmune encephalitis with anti NMDA receptor antibodies tested.In hospitals of capital city, cerebrospinal fluid or serum of 1 511 cases were tested since 2012.In other cities, 203 cases were tested since 2014.Hospitals with anti NMDA receptor antibodies tested increased by year.The cases distributed in the department of neurology, psychology, pychiatric, ICU, pediatrics, geriatrics, otolaryngology, infection, the mergency department and pneumology.② Cases with anti NMDA receptor antibodies tested increased by year.A total of 155 cases were confirmed as anti-NMDAR encephalitis, with the average onset age of (27.9±12.0) years ranged from 9 years to 77 years, including 89 women and 66 male.The female average age were (26.5±11.31) years, while the male were(29.0±13.0) years.③ Among the 155 confirmed cases, 127 cases with detailed clinical data were analyzed further.Seizure and behavior disorder were the main symptoms at onset.Among the 127 cases, 107 cases were misdiagnosed at their first hospital visit, with the misdiagnose rate of 84.3%.18 cases were reported with tumors (17 female), mainly with teratoma(11/17). ConclusionIn Sichuan province, the doctors of hospitals in non-capital city should strengthen the identification of autoimmune encephalitis.Anti-NMDAR encephalitis could be misdiagnosed easily and non-neurological physicians should also take attention;