ภาวะชักต่อเนื่องในโรงพยาบาลนครปฐม

บทคัดย่อ

Objective : The study reviewed prognostic factors and outcomes of the convulsive status epilepticus patients in Nakornpathom hospital.

Materials and methods : A retrospective study of convulsive status epilepticus patients in Nakhonpathom hospital since January 2007 - December 2009 was done. The data of sex, age, principle diagnosis, precipitating causes, complications, clinical course, anticonvulsants, length of stay and clinical outcomes from medical record were reviewed.

Results : Sixteen convulsive status epilepticus patients were found, 5 males and 11 females. Range of age was 17-86 years and range of hospitalization was 3-129 days. Patients were classified by causes of convulsivestatus epilepticus into group of 5 static lesion and 11 acute brain insult. All of 5 static lesion had precipitating factors with withdrawal of antiepileptic drugs, low therapeutic drug level and infection. After treatment all of them had good outcomes. Acute brain insult group were caused by metabolic encephalopathy, CNS infection, cerebravascular disease and malignancy. There were six mortalities of this group. Eleven of all patients responded to first line anticonvulsants whereas five of acute brain insult group were treated by second line anticonvulsants. There were 4 dead and 1 severe disability with bed ridden status from anoxic encephalopathy among patients who needed second line anticonvulsants.

Conclusion : The most of status epilepticus in this study were caused by acute brain insult (68.75%), especially metabolic encephalopathy. In the other hand the patients who previously diagnosed with epilepsy always had precipitating factors, most of them were discontinuous antiepileptic drug, infection and low therapeutic drug level respectively. Prognostic factors to predict outcome of convulsive status epilepticus in this study were the causes of status epilepticus, age of the onset and the response of first line anticonvulsants.