Status epilepticus of focal impaired-awareness seizures. Russkiy zhurnal detskoy nevrologii

Abstract

Background. The status epilepticus of focal impaired-awareness seizures (SE FIAS) is a series of focal seizures with loss or change of consciousness, between which there is no complete recovery of consciousness. This status epilepticus occurs in patients with temporal (especially with hippocampal sclerosis) and frontal epilepsy. It is important to differentiate SE FIAS with the absence status epilepticus, with psychiatric disorder, with postictal confusion. As a rule, this status epilepticus is self-terminate, without special treatment.Objective: to study the features of epidemiology, etiology, diagnosis, therapy and prognosis in patients with SE FIAS.Materials and methods. The study included 1350 consecutive patients diagnosed with epilepsy.Results and discussion. A history of SE FIAS was found in 20 patients (14 women and 6 men), it occurred in the age range from 5 to 66 years. 13 patients (65 %) had mesial temporal lobe epilepsy, 5 patients (25 %) had frontal lobe epilepsy, and 2 patients (10 %) had lateral temporal lobe epilepsy. Only in 80 % of patients treatment was adequate before the development of SE FIAS, in 20 % of patients it was inadequate and subsequently caused the development of status epilepticus. In 40 % of patients the occurrence of SE FIAS is associated with their own non-compliance; in 30 % of patients the development of status epilepticus had iatrogenic causes. Measures to prevent the development of status epilepticus were ineffective only in patients with pharmacoresistant symptomatic epilepsy and in non-compliant patients.Conclusions. SE FIAS occurs in 1 % of patients with epilepsy. Among patients, women with temporal or frontal epilepsy dominate; status epilepticus occurs at any age and is often triggered by changes in therapy due to doctors’ recommendations or patient non-compliance. Usually the status is self-terminating. To prevent its recurrence, adequate antiepileptic therapy is necessary. The prognosis in patients with SE FIAS is favorable; however, the general prognosis remains serious due to the severity of the course of epilepsy.