PATHOPHYSIOLOGY AND MORTALITY OF STATUS EPILEPTICUS

癫痫持续状态的病理生理学和死亡率

• 批准号: 7615519
• 负责人: ROBERT John DELORENZO
• 金额: $ 55.43万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7615519
• 关键词: Acute; Area; Autopsy; Bilateral; Blood Pressure; Brain; Cardiac; Cause of Death; Cessation of life; Clinical; Coma; Congenital Heart Defects; Counseling; Critiques; Data; Development; Diffuse; Electrocardiogram; Electroencephalography; Emergency Situation; Family; Frequencies; Functional disorder; Future; Grant; Guidelines; Heart; Hippocampus (Brain); Injury; Medical; Methods; Monitor; Morbidity - disease rate; Necrosis; Neurologic; Neurological emergencies; Non-Convulsive Status Epilepticus; Outcome; Pathologic; Pathology; Patients; Pattern; Physiological; Probability; Prospective Studies; Research Personnel; Risk Factors; Role; Seizures; Sensitivity and Specificity; Status Epilepticus; Sudden Death; Suggestion; Testing; Thalamic structure; Time; Treatment Protocols; base; high risk; improved; insight; mortality; outcome forecast; population based; prevent; prospective; research study; therapy development; treatment strategy; Acute; Area; Autopsy; Bilateral; Blood Pressure; Brain; Cardiac; Cause of Death; Cessation of life; Clinical; Coma; Congenital Heart Defects; Counseling; Critiques; Data; Development; Diffuse; Electrocardiogram; Electroencephalography; Emergency Situation; Family; Frequencies; Functional disorder; Future; Grant; Guidelines; Heart; Hippocampus (Brain); Injury; Medical; Methods; Monitor; Morbidity - disease rate; Necrosis; Neurologic; Neurological emergencies; Non-Convulsive Status Epilepticus; Outcome; Pathologic; Pathology; Patients; Pattern; Physiological; Probability; Prospective Studies; Research Personnel; Risk Factors; Role; Seizures; Sensitivity and Specificity; Status Epilepticus; Sudden Death; Suggestion; Testing; Thalamic structure; Time; Treatment Protocols; base; high risk; improved; insight; mortality; outcome forecast; population based; prevent; prospective; research study; therapy development; treatment strategy

DESCRIPTION (provided by investigator): Status Epilepticus (SE) is associated with significant mortality, yet little is known concerning the pathophysiological basis of death. Furthermore, there are no outcome scales to predict the probability of mortality in SE. This study will investigate predictors of mortality for SE and non convulsive SE (NCSE). Preliminary results (PR) indicate that we developed Outcome Scales for both SE and NCSE that predict mortality with a high degree of specificity and sensitivity. These Outcome Scales will be prospectively validated and improved in this study. Our PR identified After SE Ictal Discharges (ASIDS) as a major predictor of mortality and cardiac abnormalities in SE. Studies are proposed to determine the role of ASIDS in causing cardiac electrophysiological and functional abnormalities. PR indicates that ASIDS can trigger acute cardiac decompensation and death. This study will test our initial observations that increased frequency and duration of ASIDS are associated with increased mortality. We will also determine by continuous EEG and ECG monitoring whether ASIDS are associated in time with cardiac electrophysiological abnormalities and can trigger death. We also propose to conduct postmortem studies on the pathological findings in brain and heart in monitored SE patients and controls. Our PR indicated that SE causes acute ischemic and gliotic changes in the hippocampus and thalamus and is associated with specific cardiac pathology. Hypotheses will be tested in the following 5 Specific Aims. AIM 1: Prospectively validate the NCSE Outcome Scale to predict mortality in NCSE. Aim 2: Determine the effect of frequency and duration of ASIDS on mortality in SE. Aim 3: Determine the temporal relationship of ASIDS and cardiac electrophysiological and/or functional abnormalities and death. AIM 4: Determine CNS and CVS functional abnormalities prior to death and correlate with brain and heart pathologic findings. AIM 5: Prospectively validate the ability of the SE Outcome Scale to predict mortality in SE. This study may provide significant insights into the causes of mortality in SE and also develop Outcome Scales for both SE and NCSE that can be used at the bedside to identify high risk cases. The ability to recognize high risk SE and NCSE cases will offer new hope for the development of new treatment strategies for high risk cases to prevent death in SE and provide guidelines to counsel families regarding prognosis.

描述（由研究者提供）：状态癫痫症（SE）与死亡率显着有关，但关于死亡的病理生理基础知之甚少。此外，没有结果量表可以预测SE死亡率的可能性。这项研究将研究SE和非抽搐SE（NCSE）死亡率的预测指标。初步结果（PR）表明，我们开发了SE和NCSE的结果量表，这些量表以高度的特异性和敏感性来预测死亡率。在这项研究中，这些结果量表将被前瞻性验证和改进。我们的PR在SE ICTAL放电后（ASID）确定为SE死亡率和心脏异常的主要预测指标。提出了研究以确定ASID在引起心脏电生理和功能异常中的作用。 PR表明ASID可以触发急性心脏代理和死亡。这项研究将测试我们的最初观察结果，即ASID的频率和持续时间增加与死亡率增加有关。我们还将通过连续的脑电图和ECG监控确定ASID是否与心脏电生理异常有关，并可能触发死亡。我们还建议对受监测的SE患者和对照组中的大脑和心脏的病理发现进行死后研究。我们的PR表明，SE会导致海马和丘脑的急性缺血和胶质化变化，并且与特定的心脏病理有关。假设将在以下5个特定目标中进行检验。目标1：前瞻性验证NCSE结果量表以预测NCSE的死亡率。 AIM 2：确定SE中ASID的频率和持续时间对死亡率的影响。目标3：确定ASID和心脏电生理和/或功能异常和死亡的时间关系。 AIM 4：在死亡前确定CNS和CVS功能异常，并与大脑和心脏病理性发现相关。目标5：前瞻性验证SE结果量表预测SE死亡率的能力。这项研究可能会为SE中死亡率的原因提供重大见解，并为SE和NCSE开发结果量表，这些量表可在床边使用以识别高风险病例。识别高风险SE和NCSE案件的能力将为建立高风险案件的新疗法案件提供新的希望，以防止SE死亡，并为咨询家庭的预后提供指导。