EFNS guideline on the management of status epilepticus
EFNS guideline on the management of status epilepticus
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DOI：
10.1111/j.1468-1331.2006.01397.x
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发表时间：
2006-05-01
影响因子：
5.1
通讯作者：
Holtkamp, M.
中科院分区：
文献类型：
--
作者：
Meierkord, H.;Boon, P.;Holtkamp, M.
本文的目的是回顾文献，并讨论成人癫痫持续状态（SE）的各种治疗策略的证据程度。检索MEDLINE和EMBASE中1966年至2005年1月的相关文献。此外，还检索了对照试验的科克伦中心注册库（CENTRAL）。建议是基于这些文献和我们对参考文献与主题相关性的判断。通过信息丰富的协商一致方式达成了建议。在缺乏证据但共识明确的情况下，我们提出了我们的意见，作为良好做法。全身性惊厥性癫痫持续状态（GCSE）的首选治疗途径是静脉内（i. v.）给药4 mg劳拉西泮或10 mg地西泮，然后直接给药15-18 mg/kg苯妥英或等效的磷苯妥英。如果首次注射后癫痫发作持续超过10分钟，建议再注射4 mg劳拉西泮或10 mg地西泮。难治性GCSE通过咪达唑仑、丙泊酚或巴比妥类药物的麻醉剂量治疗;根据脑电图爆发抑制模式滴定麻醉剂至少24小时。非惊厥性SE的初始治疗取决于类型和原因。在大多数没有SE的情况下，小剂量的劳拉西泮或地西泮静脉注射将终止发作。复杂的部分SE最初治疗，如GCSE，然而，当难治性时，应给予进一步的非麻醉物质而不是麻醉剂。在轻微SE中，需要静脉麻醉。
The objective of the current paper was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4 mg of lorazepam or 10 mg of diazepam directly followed by 15-18 mg/kg of phenytoin or equivalent fosphenytoin. If seizures continue for more than 10 min after first injection another 4 mg of lorazepam or 10 mg of diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of midazolam, propofol or barbiturates; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on the type and the cause. In most cases of absence SE, a small i.v. dose of lorazepam or diazepam will terminate the attack. Complex partial SE is initially treated such as GCSE, however, when refractory further non-anaesthetising substances should be given instead of anaesthetics. In subtle SE i.v. anaesthesia is required.