Treatment of status epilepticus: a survey of neurologists
Treatment of status epilepticus: a survey of neurologists
复制标题
DOI：
10.1016/s0022-510x(03)00036-4
复制
发表时间：
2003-07-15
影响因子：
4.4
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Hirsch, LJ;Mayer, SA
背景：新型抗癫痫药物（aed）为传统的癫痫持续状态（SE）治疗模式提供了替代方案。方法：为了确定目前对全身性惊厥癫痫持续状态（GCSE）的治疗偏好，我们调查了美国神经病学学会重症监护或癫痫科的106名成员。结果：大多数应答者最初给患者静脉注射劳拉西泮（76%），如果一线治疗失败，则使用苯妥英或磷苯妥英（95%）。对两种aed （RSE）难治的GCSE患者的偏好各不相同：43%的患者选择苯巴比妥，19%的患者选择三种持续输注（cIV） aed（戊巴比妥、咪达唑仑、异丙酚）中的一种，16%的患者选择静脉注射丙戊酸。大约一半的患者认为“抑制发作”（56%）和一半的患者认为“消除癫痫发作”（41%）是cIV-AED治疗的滴定目标。大约一半（42%）的患者会添加新的cIV-AED，而另外一半（41%）的患者不会添加其他药物来治疗四种aed难治性电性SE。讨论：根据已发表的试验和一般指南，神经科医生最常使用劳安定和苯妥英或磷苯妥英作为GCSE的一线和二线治疗。对于RSE的三线或四线治疗尚无共识。RSE的治疗需要在大型、前瞻性、随机、多中心的试验中进行研究。(C) 2003 Elsevier Science B.V.版权所有
Background: New antiepileptic drugs (AEDs) have provided alternatives to traditional treatment paradigms for status epilepticus (SE). Methods: To deter-mine current treatment preferences for generalized convulsive status epilepticus (GCSE), we surveyed 106 members of the Critical Care or Epilepsy sections of the American Academy of Neurology. Results: Most respondents initially treat patients with intravenous (IV) lorazepam (76%), followed by phenytoin or fosphenytoin (95%) if first-line therapy fails. Preferences for GCSE refractory to two AEDs (RSE) varied: 43% would give phenobarbital, 19% would give one of three continuous-infusion (cIV) AEDs (pentobarbital, midazolam, propofol), and 16% would give IV valproic acid. About half indicated "burst suppression" (56%) and half indicated "elimination of seizures" (41%) as the titration goal for cIV-AED therapy. About half (42%) would add a new cIV-AED, and the other half (41%) would not add another agent to treat electrographic SE refractory to four AEDs. Discussion: In accordance with published trials and general guidelines, neurologists most often use lorazepam followed by phenytoin or fosphenytoin as first-line and second-line therapies for GCSE. There is no consensus for third-line or fourth-line treatment for RSE. The treatment of RSE needs to be studied in a large, prospective, randomized, multicenter trial. (C) 2003 Elsevier Science B.V. All rights reserved.