Stanisław Nowak, Irena Florin-Dziopa, Barbara Błaszczyk, Ewa Kołodziejska, Wojciech Nowak, Elżbieta Nowak, Przemysław Nowak, Sławomir Szmatoła

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Analizie poddano stan padaczkowy (SP) uogólnionych napadów drgawkowych u chorych dorosłych w latach 1969-2003. Badana populacja powyżej 18. r.ż. wynosiła ok. 800 tys. osób.

Słowa kluczowe: stan padaczkowy, etiologia, klinika, czynniki prowokujące stan padaczkowy.

The analysis was performed in 495 cases of convulsive status epilepticus of primary or secondarily generalized tonic - clonic attacks, treated during 1969-2003 years. There were 270 males (54.5%) and 225 females (45.5%) in this group. In age group 18-29 years there were in general 73 patients (14.7%), including M - 46 (17%), F - 27 (12%), 30-39 years - 78 patients (15.8%) including M - 50 (18.5%), F - 28 (12.4%), in age group 40-49 years - 91 patients (18.4%) including M - 53 (19.6%), F - 40 (17.8%), in age group 60-69 years - 89 (18%) including M - 41 (15.2%), F - 48 (21.3%), in age group 70-79 years - 66 (13.3%) including M - 33 (12.2%), F - 33 (14.7%), and in age group 80-89 years - 16 (3.2%) including M - 5 (1.9%), F - 11 (4.9%). First time status epilepticus occurred in 406 patients, including M - 225 (55.4%), F - 181 (44.6%) in age group 18-29, in general there were 61 patients (15%), M - 39 (17.3%), F - 22 (12.2%), in age group 30-39 years - 65 patients (16%), M - 41 (18.2%), F - 24 (13.3%), in age group 40-49 years - 76 patients (18.7%), M - 44 (19.6%), F - 32 (17.7%), in age group 50-59 years - 71 (17.5%), M - 36 (16%), F - 35 (19.3%), in age group 60-69 years - 73 patients (18%), M - 34 (15.1%), F - 39 (21.5%), in age group 80-89 years - 52 patients (12.8%), M - 28 (12.4%), F - 24 (13.3%) and in age group 80-89 years - 8 patients (2%), M - 3 (1.3%), F - 5 (2.7%). Second time status epilepticus occurred in 66 patients, including M - 37 (56%), F - 29 (44%). In general in this group there were - in age group 18-29 years there were 10 patients (15.2%) M - 6 (16.2%), F - 4 (13.8%), in age group 30-39 years - 11 (16.7%), M - 8 (21.6%), F - 3 (13.8%), in age group 40-49 years - 11 patients (16.7%), M - 7 (18.9%), F - 4 (13.8%), in age group 50-59 years - 9 patients (13.6%), M - 5 (13.5%), F - 4 (13.8%), in age group 60-69 years - 12 patients (18.2%), M - 6 (16.2%), F - 6 (20.7%), in age group 70-79 years - 9 patients (13.6%), M - 4 (10.8%), F - 5 (17.2%), and 80-89 years - 4 patients (6%), M - 1 (2.7%), F - 3 (10.3%). In a group of repeated status epilepticus (more then three ) there were 23 patients M - 8 (35%), F - 15 (65%). In a whole group, in the age groups 18-29 years, 30-39 years, 50-59 years there were 1 patient respectively (8.7%), M - 1, F - 1, in age group 40-49 years there were 4 patients (17.4%), M - 2, F - 2, in age group 60-69 years there were 4 patients (17.4%), M - 1, F - 3, in age group 70-79 years there were 5 patients (21.7%), and in age group 80-89 years there were 4 patients (17.4%), M - 1, F - 3. In a whole studied group, the duration of disease was from 6 months to more then 30 years mean 16,8 years). About 50% of patients had primary generalized attack, the rest - secondary generalized, mostly simple partial attacks. The frequency of generalized attacks was from 4-6 more than 14 a year, and partial attacks - from some to a dozen or so, in more than 30% - adversive attacks. In younger age groups, mainly in males, traumatic factor was prevailing - 42%, concerned greatly with alcohol abuse, in females - 21%. In 16% males as well as females, inflammatory processes of central nervous system were prevailing, vascular changes in about 15%, tumours in 8%, early childhood brain damages in about 4%. In other cases, it was impossible to specify any etiologic factor. In age group of above 60 years in males as well as in females, vascular lesions of brain were prevailing - about 43%, craniocerebral trauma in 12%, tumours in 16%, cerebral atrophy and other organic lesions of brain in 14%, past inflammatory processes of brain in about 9%. In part cases, etiologic factor was not established. Status epilepticus was mainly due to discontinuation of antiepileptic drugs or diminishing the dose, it was often connected with alcohol abuse, mainly in males. This phenomenon was occurring also during treatment of other disease, e. g. infections, diseases of alimentary tract, urinary tract, metabolic diseases, pregnancy, hormonotherapy. There were also cases of advices - also by a physician, non - neurologist - to diminish significantly the dose of drug, or simply discontinue the drug (pregnancy, hormonotherapy, antibiotic therapy). Beneficial phenomenon of earlier than before hospitalization of patients with status epilepticus, and more intensive care units were observed, which affects the prognosis of these patients. The deaths were about 9% in lasty years, and above 22% in 1963-1968 years. Unfavourable phenomenon, observed mainly in younger age groups was an excess of TV, computer games, discoteques, sleep deprivation with irregular drug therapy which also produces status epilepticus. We were using typical treatment in an intensive care unit typical drugs. In about 5% of prolonged status epilepticus anesthesia was necessary. Percentages given according to the whole group and to males and females.

Key words: status epilepticus, etiology, factors provoking status epilepticus.