The anesthetic drug treatment of refractory and super-refractory status epilepticus around the world: Results from a global audit
The anesthetic drug treatment of refractory and super-refractory status epilepticus around the world: Results from a global audit
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DOI：
10.1016/j.yebeh.2019.106449
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发表时间：
2019-12-01
影响因子：
2.6
通讯作者：
Shorvon, Simon
中科院分区：
文献类型：
--
作者：
Ferlisi, Monica;Hocker, Sara;Shorvon, Simon
多国和多中心登记收集难治性和超难治性癫痫持续状态病例，有助于了解目前治疗这类疾病的做法，并可以改进合理的治疗。我们通过50个国家的治疗医生编制的在线问卷，前瞻性地收集了776例重症监护病房中需要持续静脉麻醉药的难治性癫痫持续状态患者。与高收入国家相比，中等收入国家静脉麻醉药的启动时间相对较晚。在初始静脉麻醉药的选择上存在明显的地区差异。一般来说，咪达唑仑是最常用的初始麻醉药(56%)，其次是异丙酚(35%)，在欧洲，丙泊酚比咪达唑仑更受欢迎。除麻醉外，26%的病例接受了某种形式的免疫抑制(使用皮质类固醇和/或静脉注射免疫球蛋白)。在这项观察性研究中，结果不受麻醉药物的选择或顺序的影响，巴比妥类麻醉药的使用也与较差的结果无关。即使在早期麻醉药失效后，患者对不同麻醉药周期的反应比例也很高，但随着麻醉药使用时间的延长和癫痫持续时间的延长，神经结局逐渐恶化。然而，即使在158名需要三种或更多不同麻醉剂试验的患者中，49%的患者在逐渐减少第三种麻醉剂时癫痫发作得到控制，20%的患者在任何地方都有良好的神经学结果。出于这些原因，我们认为，对于最初难以治愈的患者，坚持治疗是重要的，特别是因为病因，而不是麻醉持续时间的数量，是决定预后的主要因素。本文是特刊《第七届伦敦会议论文集-因斯布鲁克研讨会关于癫痫持续状态和急性癫痫发作》的一部分(C)2019年爱思唯尔公司。保留所有权利。
Multinational and multicenter registries collecting cases of refractory and super-refractory status epilepticus help to understand what the current practice in the treatment of such conditions is and can improve the rational therapy. We prospectively collected 776 cases of refractory status epilepticus requiring continuous intravenous anesthetic drugs in an intensive care unit setting, through online questionnaires compiled by the treating physicians in 50 countries. Initiation of an intravenous anaesthetic drug was relatively delayed in middle-income compared with high-income countries. There were marked regional differences in the choice of initial intravenous anaesthetic drug. Generally, midazolam was the most commonly used initial anesthetic drug (56%), followed by propofol (35%), in Europe, propofol was preferred over midazolam. In addition to anesthesia, 26% of cases received some form of immunosuppression (with corticosteroids and/or intravenous immunoglobulin). In this observational study, outcome was not affected by choice or sequence of anesthetic drugs, and nor was the use of barbiturate anesthetics associated with poorer outcome. The proportion of patients responding to cycles of different anaesthetic drugs was high even after failure of the earlier anesthetics, but the neurological outcome progressively worsened the longer anaesthetic drugs were needed and the longer the status epilepticus continued. However, even in the 158 patients who required three or more different anaesthetic trials, 49% had seizure control on tapering the third anesthetic, and 20% had a good neurological outcome anywhere. For these reasons we believe that it is important to persist with therapy in patients who are intractable initially, especially as etiology, not the number of duration of anesthesia, is the primary determinant of prognosis.This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures" (c) 2019 Elsevier Inc. All rights reserved.