Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors,Neurocritical Care

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Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors
Neurocritical Care ( IF 3.1 ) Pub Date : 2023-11-08 , DOI: 10.1007/s12028-023-01868-1
Clara Marie Bode ₁ , Simon Bruun Kristensen ₁ , Hanne Tanghus Olsen ₂ , Camilla Dyremose Cornwall _{1,

3} , Lars Roberg ₁ , Olav Monsson ₁ , Thomas Krøigård _{1,

3,

4} , Palle Toft _{2,

3} , Christoph P Beier _{1,

3,

5}

Affiliation

Background

Postictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge.

Methods

This retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records.

Results

Of all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade.

Discussion

In this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.

中文翻译：

癫痫持续状态后的发作后脑病：结果和危险因素

背景

癫痫持续状态 (SE) 后的发作后脑病是众所周知的，但其预后影响和触发因素尚不清楚。在这里，我们的目的是确定发生发作后脑病的危险因素，并研究其对出院后生存的影响。

方法

这项回顾性队列研究包括 2008 年 1 月至 2017 年 12 月期间在欧登塞大学医院诊断出首次非缺氧 SE 的成年患者。出院时持续出现 SE 或治疗成功率未知的患者被排除在外。使用 West Haven 标准 (WHC) 回顾性评估脑病的发作后症状。 WHC 等级是在发作后第 1 至 14 天或直到患者死亡或出院时确定的。 SE 停止后 14 天内的累积发作后 WHC 用于量化发作后脑病。根据医疗记录评估临床特征、患者人口统计、脑电图和影像学特征以及重症监护治疗的详细信息。

结果

在所有符合条件的患者中 ( n = 232)，198 名 (85.3%) 患有至少 WHC 2 级发作后脑病，24.5% 的幸存患者中持续时间 > 14 天。出院时的 WHC 等级与长期生存率差密切相关 ( p < 0.001)。发作后脑病与非惊厥性 SE、磁共振成像的发作后变化或脑电图的独特发作模式无关。尽管 SE 持续时间和重症监护室治疗显示与累积的发作后 WHC 分级相关，但在控制混杂因素时，它们与脑病程度并不独立相关。在线性回归模型中，病因、镇静持续时间、年龄和病前改良 Rankin 量表是较高累积发作后 WHC 等级的显着且一致的预测因子。探索性分析显示累积咪达唑仑剂量 (mg/kg/h) 与较高的累积发作后 WHC 等级相关。