Treatment of status epilepticus
Treatment of status epilepticus
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DOI：
10.1055/s-2008-1079339
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发表时间：
2008-07-01
影响因子：
2.7
通讯作者：
Hirsch, Lawrence J.
中科院分区：
文献类型：
--
作者：
Arif, Hiba;Hirsch, Lawrence J.
癫痫持续状态 (SE) 是一种神经急症，需要及时诊断和治疗，因为延迟很可能导致治疗反应不佳和结果更差。劳拉西泮已被确立为一线疗法。后续步骤尚未确定，但有许多合理的选择，包括静脉注射磷苯妥英、丙戊酸钠、咪达唑仑、丙泊酚和苯巴比妥。如果无法立即进行静脉注射，则应给予直肠地西泮或鼻腔或口腔咪达唑仑；这也可以用作院外治疗来预防或治疗 SE。对于难治性 SE，连续静脉注射咪达唑仑和异丙酚，单独或联合使用，可迅速起效，而戊巴比妥仍然是长期病例的金标准。如果患者在治疗后未苏醒，应紧急进行脑电图（EEG）检查以排除非惊厥性癫痫发作。在难治性 SE 中，需要持续脑电图监测来识别癫痫发作活动的复发，因为大多数癫痫发作都是非惊厥性的。
Status epilepticus (SE) is a neurological emergency that requires prompt diagnosis and treatment, as delay is associated with a higher likelihood of poor response to treatment and worse outcome. Lorazepam has been well established as a first-line therapy. Subsequent steps are less established, and there are many reasonable options, including intravenous fosphenytoin, valproate, midazolam, propofol, and phenobarbital. If intravenous access is not immediately available, rectal diazepam or nasal or buccal midazolam should be given; this can also be used as out-of-hospital treatment to prevent or treat SE. For refractory SE, continuous intravenous midazolam and propofol, separately or in combination, are rapidly effective, with pentobarbital remaining the gold standard for prolonged cases. If a patient does not awaken after treatment, urgent electroencephalogram ( EEG) should be obtained to rule out nonconvulsive seizure activity. In refractory SE, continuous EEG monitoring is required to recognize recurrence of seizure activity, as most seizures will be nonconvulsive.