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沈丛萍1 宁金环1 刘肇绩2 郑维红2 刘赞华1▲.老年全面惊厥性癫痫持续状态的临床研究[J].中国现代医生,2021,59(27):110-113+117
老年全面惊厥性癫痫持续状态的临床研究
Clinical study of generalized convulsive status epilepticus in the elderly
  
DOI:
中文关键词:  老年  全面惊厥性癫痫持续状态  病因  预后
英文关键词:Elderly  Generalized convulsive status epilepticus  Etiology  Prognosis
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作者单位
沈丛萍1 宁金环1 刘肇绩2 郑维红2 刘赞华1▲ 1.南京市高淳人民医院神经内科江苏南京 2113002.厦门大学附属中山医院神经内科福建厦门 361004 
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中文摘要:
      目的 确定老年全面惊厥性癫痫持续状态患者的临床特点、病因、治疗效果以及预后。方法 收集2007 年10 月至2020 年12 月在南京市高淳人民医院和厦门大学附属中山医院神经内科住院治疗的全面惊厥性癫痫持续状态患者共231例。根据年龄60 岁为界,≥60 岁为老年组;<60 岁为中青少年组(以下简称对照组)。分析和比较全面惊厥性癫痫持续状态的老年组和对照组的临床特征(全面惊厥性癫痫持续状态的病因、发病诱因、脑电图、磁共振检查)、临床疗效和不良反应。结果 全面惊厥性癫痫持续状态的老年患者在70~79 岁之间人群中发病率最高,老年患者容易在首次癫痫发作时就出现全面惊厥性癫痫持续状态(χ2=4.111,P=0.029),老年组最常见的原因是脑血管病(χ2=4.589,P=0.032)和痴呆(χ2=7.632,P=0.006),感染诱发比较常见(χ2=10.157,P=0.001)。老年患者在苯二氮pagenumber_ebook=116,pagenumber_book=110类治疗组和丙戊酸钠治疗组的疗效比较,差异无统计学意义(P>0.05),与对照组比较差异也无统计学意义(P>0.05)。但老年组出院时的mRS 评分(0.67±0.14)分,明显高于对照组的(0.28±0.09)分,差异有统计学意义(t=2.074,P=0.039),出院时老年组的死亡率明显高于对照组,差异有统计学意义(χ2=4.074,P=0.046)。结论 在老年人群中,没有癫痫病的患者更容易发生全面惊厥性癫痫持续状态,老年患者最常见的病因是由脑血管疾病和痴呆引起的。各年龄组之间采用苯二氮pagenumber_ebook=116,pagenumber_book=110类和丙戊酸钠治疗的疗效无明显差异。全面惊厥性癫痫持续状态的老年患者预后较差和有较高的死亡率。
英文摘要:
      Objective To determine the clinical characteristics,etiology,therapeutic effects and prognosis of elderly patients with generalized convulsive status epilepticus.Methods A total of 231 patients with generalized convulsive status epilepticus admitted to the Neurology Department in Gaochun People′s Hospital of Nanjing city and Zhongshan Hospital Affiliated to Xiamen University from October 2007 to December 2020 were selected.Taking the age of 60 years old as the boundary,≥60 years old were the elderly group;<60 years old were the middle adolescent group(hereinafter referred to as the control group).The clinical features (etiology,predisposing factors,EEG,MRI examination),clinical efficacy and adverse reactions of the elderly group and the control group with generalized convulsive status epilepticus were analyzed and compared.Results Elderly patients with generalized convulsive status epilepticus had the highest incidence among the population between the ages of 70 to 79.Elderly patients were more prone to develop the generalized convulsive status epilepticus at the first seizure (χ2=4.111,P=0.029).The most common cause in the elderly group was cerebrovascular disease (χ2=4.589,P=0.026) and dementia (χ2=7.632,P=0.006),and it was relatively common induced by infection (χ2=10.157,P=0.001).There was no significant difference in the efficacy of elderly patients between the benzodiazepines treatment group and the sodium valproate treatment group (P>0.05),and there was also no significant difference compared with the control group(P>0.05).However,the mRS score (0.67±0.14) points at discharge in the elderly group was higher than that of(0.28±0.09)points in the control group,with significant difference(t=2.074,P=0.039).The death rate in the elderly group at discharge was higher than that in the control group,with statistically significant difference (χ2=4.074,P=0.046).Conclusion In the elderly population,patients without epilepticus are more likely to develop generalized convulsive status epilepticus,and the most common etiology in elderly patients is caused by cerebrovascular disease and dementia.There is no difference in the efficacy of treatment with benzodiazepines and sodium valproate among all age groups.Elderly patients with generalized convulsive status epilepticus have a poor prognosis and a higher mortality rate.
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