ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ HIỆU QUẢ ĐIỀU TRỊ TRẠNG THÁI ĐỘNG KINH

Abstract

Backgound: Status epilepticus (SE) is a neurological emergency requiring immediate evaluation and management to prevent mortality. This study aims to investigate the clinical characteristics, paraclinical findings, treatment efficacy, and outcomes of SE patients at People's Hospital 115. Methods: A cross-sectional descriptive study was conducted from January 2024 to September 2024 at the Department of General Neurology, People's Hospital 115, involving patients aged 16 years and older diagnosed with SE based on the 2015 classification by the International League Against Epilepsy (ILAE) and Salzburg criteria.^2,3 Exclusion criteria: patients with seizures due to acute metabolic disorders. Results: The median age of the study population was 53.9 years, with a male-to-female ratio of 13:7. Medical history revealed that 95% of patients had underlying conditions, of which 35% had a history of epilepsy. The most common type of SE was tonic-clonic SE (65%), followed by focal motor SE with impaired awareness (25%) and non-convulsive SE (10%). Paraclinical results showed that 100% of EEGs recorded during seizures confirmed epileptic activity, while only 10% of interictal EEGs detected epileptiform discharges. Imaging studies identified abnormalities in 78.9% of cases, with lesion detection rates of 81.9% on MRI and 72.7% on CT. Cerebrospinal fluid abnormalities were found in 4 out of 7 cases, with no evidence of infection; one case involved anti-NMDA receptor encephalitis. The main cause of SE was chronic lesions (55%), followed by cryptogenic causes (25%) and acute lesions (20%). The median time to treatment initiation was 9.9 minutes. The overall treatment response rate was 85%. By SE type, the highest response rate was observed in focal motor SE with impaired awareness (100%), followed by tonic-clonic SE (84.6%) and non-convulsive SE (50%). By etiology, chronic lesions had the highest treatment response rate (90.9%), followed by cryptogenic causes (80%) and acute lesions (75%). Conclusion: This study highlights the need for early recognition, diagnosis, and timely treatment of SE to improve prognosis. Early EEG monitoring, particularly in cases of non-convulsive SE, is essential for classification, monitoring, and treatment. Future implementation of bedside EEG monitoring is recommended to enhance the diagnosis and management of SE.