Status epilepticus: Ursache, Verlauf und Therapie bei 100 Patienten

Abstract

100 patients suffering from status epilepticus (SE) were investigated. 63 patients suffered from SE with tonic-clonic seizures, 15 patients from absence status, 19 patients from SE with simple partial seizures and 3 patients from SE with complex partial seizures. SE with tonic-clonic seizures seems to be common, SE with complex-partial seizures a rare type of SE. The latter might, however, often be misdiagnosed because of its nonconvulsive symptomatology. In patients with absence status and SE with complex-partial seizures SE used to occur during the course of a chronic epileptic disorder, whereas in SE with simple partial seizures and SE with tonic-clonic seizures, acute cerebral diseases lead in most cases to SE in patients who had never before suffered from epileptic seizures. Thus, the interval between SE and the onset of epilepsy was in 46 out of 82 patients (56%) with the latter seizure types less than 2 years. Besides etiology, precipitating factors are of great importance in triggering SE, especially alcohol abuse and withdrawal of antiepileptic drug therapy. For the diagnosis of SE the EEG is highly decisive, although epileptiform discharges (generalized spike wave paroxysm) regularly are detected only in absence status. In the other types of SE, EEG signs are often only a slowing of background activity while epileptiform discharges were found in only 29% of the patients. None of the patients died during SE or in the following 4 weeks. Therapy was with benzodiazepines in 45%, phenytoin in 20%, benzodiazepines and Phenytoin in 26%, benzodiazepines, phenytoin and phenobarbetal in 7% and clomethiazol in 2%.