When benzodiazepines fail: how effective is second line therapy for status epilepticus in children?
When benzodiazepines fail: how effective is second line therapy for status epilepticus in children?
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DOI：
10.1111/j.1742-6723.2006.00807.x
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发表时间：
2006-02-01
期刊：
影响因子：
--
通讯作者：
Young, Simon
中科院分区：
文献类型：
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作者：
Lewena, Stuart;Young, Simon
目的：明确因惊厥性癫痫持续状态（CSE）就诊于大型三级儿科医院艾德的儿童的特征和治疗。要确定的时间和疗效的治疗干预措施，在这一组，并确定影响因素的有效性treatment.METHOD：一个回顾性审计的所有儿童谁提出了一个艾德的三级儿科医院在CSE3 yearperiod.RESULTS：37例被确定。51%的患者接受了院前治疗。一线和二线治疗联合治疗，30%的患者实现了无并发症的癫痫控制。70%的患者需要麻醉的快速序列诱导（RSI）来控制持续的癫痫发作活动（21例）或支持严重的呼吸抑制（5例）。在癫痫发作持续时间超过30分钟的患者中，RSI要求增加到85%，在接受院前治疗的患者中，RSI要求增加到89%。那些谁需要RSI，35%的治疗期间超过60分钟之前，这种干预performed.CONCLUSIONS：标准的二线抗惊厥治疗是相对无效的终止癫痫发作的儿童谁提出的CSE不响应苯二氮卓类药物。院前治疗无效和癫痫发作持续时间延长都预示着治疗效果差。在等待二线治疗发挥作用时，麻醉RSI的三线治疗经常被延迟。
OBJECTIVES: To define the characteristics and management of children presenting to the ED of a major tertiary paediatric hospital with convulsive status epilepticus (CSE). To determine the timing and efficacy of therapeutic interventions in this group and to identify factors that influence the effectiveness of treatment.METHOD: A retrospective audit of all children who presented to an ED of a tertiary paediatric hospital in CSE over a 3 year period.RESULTS: Thirty-seven cases were identified. Prehospital treatment had been administered in 51%. Uncomplicated seizure control was achieved in 30% with the combination of first and second line therapy. Rapid sequence induction (RSI) of anaesthesia was required in 70% for the control of ongoing seizure activity (21 cases) or to support severe respiratory depression (five cases). This requirement for RSI was increased to 85% in those with seizure duration in excess of 30 min and 89% of those who received prehospital treatment. Of those who required RSI, 35% were treated for periods in excess of 60 min before this intervention was performed.CONCLUSIONS: Standard second line anticonvulsant treatment was relatively ineffective in terminating seizures in children who presented in CSE not responsive to benzodiazepines. Failure to respond to prehospital treatment and prolonged seizure duration at presentation both predict poor therapeutic response. Third line treatment with RSI of anaesthesia is often delayed while waiting for second line treatment to work.