【摘要】 目的 探讨癫痫持续状态引起的脑部异常MRI表现的特点。 方法 回顾分析2004年—2007年5例患者由癫痫持续状态引起的脑部异常MRI表现，患者均在发作后72 h内行头颅MRI检查，常规进行了T2WI、T1WI、液体衰减反转恢复序列、弥散加权成像（diffusion-weighted imaging，DWI），同时进行了磁共振血管造影（magnetic resonance angiography，MRA）及增强扫描。 结果 5例患者均由部分性发作泛发为全面性强直-阵挛发作，均在发作后行MRI时出现明显单侧大脑半球异常表现，且与部分性发作侧相对应，在T2WI上均表现为局部皮层肿胀，呈高信号，其中3例DWI上出现皮层高信号，病灶不按脑血管分布。4例在MRA上出现病灶同侧大脑中动脉血管较对侧明显增多。5例行增强扫描后均见病灶侧脑膜明显强化。5例患者临床发作后均遗留有与MRI异常病灶相应的临床神经功能缺失。其中3例病情稳定后复查MRI，发现异常病灶及MRA完全恢复正常。 结论 癫痫持续状态引起脑部异常MRI表现特点：①常局限于大脑皮层的T2WI、DWI高信号，且病灶不按血管分布区分布；②MRA提示单侧脑血管增多；③增强扫描见单侧脑膜强化。大部分病灶可逆。这些特点可用来区别是癫痫引起的异常病灶还是脑部的致痫灶。【Abstract】 Objective To summarize the characteristics of abnormal MRI findings of brain caused by status epilepticus. Methods We retrospectively analyzed the abnormal MRI findings of brain in five patients with status epilepticus from 2004 to 2007. All of them received MRI examination within 72 hours after seizures, including the routine examination of T2WI, T1WI, FLAIR and diffusion-weighted imaging (DWI). Meanwhile, MRA and enhancement scanning were carried out. Three of them were reexamined with MRI after the disease came into a stable condition. Results All the five patients transferred from partial seizures initially to generalized tonic clonic seizures, and obvious abnormal MRI findings were detected at the unilateral cerebral hemisphere, corresponding to the side of partial seizures. They appeared regional swelling of cortex with high signal in T2WI, and three cases were found with cortex high signals in DWI, which were not distributed according to cerebral vessels. In four cases, we found that the branches of the middle cerebral artery increased markedly than the contralateral branches on the ipsilateral lesions in MRA. Enhancement scanning also showed that the meninges at the side of the lesion was strengthened significantly in five cases. The loss of neurological functions corresponding to abnormal lesions in MR remained after seizures in five cases among whom three patients recovered completely in terms of their abnormal focuses and MRA findings after their diseases came into a stable condition. Conclusions The features of abnormal brain MRI findings caused by status epilepticus are: ① High signals in T2WI and DWI are confined to the cortex, and the focuses are not distributed according to cerebral vessels; ② MRA shows that unilateral cerebral vessels increases in number; ③ Strengthened unilateral meninges can be observed in enhanced scanning and most of lesions are reversible. According the characteristics, we can distinguish the abnormal lesions caused by epilepsy from focuses in the brain causing epilepsy.
ObjectiveTo investigate the etiology, clinical features, treatment, and prognosis of Partial status epilepticus (PSE). MethodsSeventeen PSE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from April 2013 to June 2015. Clinical data were retrospectively analyzed. ResultsA total of 17 patients, 8 male and 9 female, 18~91years old, at mean age (48.90±21.17) years were included. About 12 cases (70.59%) had acute symptomatic status epilepticus, the etiologies including central nervous system inflammation (5 cases), cortical infarction (3 cases), metabolic disorder (1 case), hypoxic-ischemic encephalopathy (1 case), space-occupying lesions(1 case) and degeneration (1 case); four cases (23.53%) were diagnosed with epilepsy, one case (5.88%) had no definite pathogenesis. The seizure types included complex partial status epilepticus (8 cases, 47.06%), complex part of the secondary comprehensive status epilepticus (3 cases, 17.65%), supplementary motor area (SMA) status epilepticus (4 cases, 23.53%), epilepsia partialis continua (EPC) (1case, 5.88%)and complex partial status epilepticus & aura continua (1case, 5.88%). Nine cases (52.94%) were effective after one hour treament, eight cases (47.06%) were negative. 17 cases are followed-up and 4 cases lost, the average follow-up time is (10.89±8.64) months. 8 cases are completely seizure free, and 3 cases have experience less seizures or the symptom is relived; the other 2 cases die from Creutzfeldt-Jacob desease(case No.10) and Respiratory failure(case No.12). ConclusionsThe inpatients of partial status epilepticus are mostly "situation related". Patients with clinical suspect should be administrated with long term video-Electroencephalogram(EEG) monitoring timely. Early diagnosis, treatment and the aggressive treatment can help to improve the prognosis. Patients of encephalitis usually progress into refractory status epilepticus, the anesthetic drugs should be used as soon as possible.
ObjectiveTo observe the dynamic changes of neuroglobin (NGB) expression in hippocampus after status epilepticus(SE) in rats, and to explore the role of NGB in epileptic seizures.Methods40 healthy male Sprague Dawley rats were randomly divided into two group according to random number table method:control group (n=5) and epilepsy model group(n=35).Epilepsy model group according to observation time was divided into:0h, 1h, 3h, 12h, 24h, 10d and 30d.Intraperitoneal injection Lithium-pilocarpine (20 mg/kg~127 mg/kg, Li-PC) to establish the rat model of SE.Observe the behavioral changes in rats with epilepsy.Nissl staining was used to detect the neuronal damage in hippocampus. Streptavidin-biotin-peroxidase complex immunohistochemical method was used to detect the expression level of NGB in hippocampus;ResultsAfter SE, the neurons in hippocampus were severely damaged with the progress of epileptic seizures, the number of surviving neurons in CA1, CA3 regions showed a near linear decline.Among them, the number of surviving neurons in (12h, 24h, 10d, 30d)CA1, (0h, 12h, 24h, 10d, 30d)CA3 and(12h, 24h, 10d, 30d) DG area were significantly lower than that of the control group (P < 0.05).The expression level of NGB in CA1, CA3 and DG region of hippocampus were increased after SE, and both of CA1 and DG were reached peak in 24h after SE, but was still higher than the control group.And the CA3 area showed a continue rising trend.Among them, CA1(24h, 10d, 30d), CA3(24h, 10d, 30d) and DG(12h, 24h, 10d, 30d) were higher than that of control group significantly (P < 0.05).In addition, it was found that there was a positive correlation between the number of surviving neurons in CA3 area and the expression level of NGB (R=0.306, P=0.011).ConclusionUp-regulation of NGB expression in hippocampus after status epilepticus, and was positively correlated with the number of neurons in the CA3 area, suggesting that up regulation of NGB expression may be a compensatory protective mechanism of ischemic injury induced by seizures, and participate in the protection of epilepsy related neuronal damage.
Objective To study the factors that affect the prognosis of status epilepticus (SE) and to improve the understanding of clinicians. Methods A retrospective analysis of 57 patients with SE witch from the General Hospital of Ningxia Medical University and Cardio-cerebrovascular Disease Hospital were carried out to collect their clinical data. The data were analyzed by SPSS 17.0 software. The prognosis of the patients was assessed by the Status epilepticus severity score (STESS) scale. Results A total of 57 patients were included, 53 cases improved, 4 cases were automatically discharged. Telephone follow-up showed that 4 cases of automatic discharge were dead. The mortality rate of SE was 7.02%. The most common cause of SE was acute cerebrovascular disease (17.54%), followed by intracranial infection (10.53%); The most common incidence were the occasional medication, self-medication, withdrawal (15.79%). Age, state of consciousness and concurrent infection were associated with prognosis (improvement/death) (P<0.05). STESS score of 0 to 2 points were 45 patients, all improved; score of 3 to 5 points were 12 patients, 8 patients improved, 4 patients died. There were significant differences in the prognosis between the two groups (P<0.05). Conclusions Age, state of consciousness, concurrent infection were related to prognosis, more than 65 years, the state of consciousness for the sleeping or coma had the poor prognosis. STESS scale can predict the prognosis of patients effectively.
Febrile infection-related epilepsy syndrome (FIRES) is a rare and severe epileptic encephalopathy characterized by critical illness, complex nursing requirements, the need for multidisciplinary collaboration, and high-intensity care during its acute phase. Based on a review of relevant literature and specific nursing practices, this article summarizes the latest advancements in the acute-phase care of children with FIRES. It focuses on aspects such as the management of status epilepticus, fever care, airway management, nutritional support and ketogenic diet, family support, and multidisciplinary collaboration. The aim is to provide a reference for clinical nursing practices and related research.
Purpose To analyze the clinical characteristicsand prognostic factors of Status epilepticus (SE) in children. Methods The clinical data of 33 children with SE treated in Jinan Central Hospital Affiliated of Shandong University from January 2014 to June 2021 were collected, and their clinical characteristics were analyzed. Then, according to Glasgow prognosis scale, the children were divided into good prognosis group (n=20) and poor prognosis group (n=13). The age of first attack, duration of attack, type of attack and SE classification, EEG, cranial imaging and etiology were used to analyze the influencing factors of SE prognosis. Results 75.7% were 0 ~ 6 years old in the age of first attack, and 29 cases of convulsive status epilepticus accounted for 87.9% in the classification of seizure types. There were significant differences in age of first attack, duration of attack, EEG, history of mental retardation and etiology between the two groups (P<0.05); Logistic regression analysis showed that the age of first attack, duration of attack, history of mental retardation and EEG were independent factors affecting the prognosis. Conclusion Low age, especially ≤ 6 years old, is the high incidence of SE in children at first attack. Most children are symptomatic and have obvious incentives. Convulsive SE is the main type of SE in children. The age of first onset, duration of epilepsy, history of mental retardation, and EEG can affect the prognosis of SE.
Status epilepticus (SE) is one of the most common neurological emergencies. Prolonged seizures can cause permanent neuronal death in the central nervous system, necessitating early recognition and timely intervention. Although there is some consensus on the diagnosis and treatment of SE, the high heterogeneity of SE patients presents a significant challenge for standardized management and prognosis prediction. This review summarizes the current research progress on the diagnosis, treatment, and prognosis of SE, aiming to provide references for early diagnosis, early treatment, and early prediction of prognosis.