耐火材料普遍抽搐的癫痫持续状态:治疗指南。

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Kalviainen R,埃里克森K, Parviainen我

耐火材料普遍抽搐的癫痫持续状态:治疗指南。

中枢神经系统药物。2005;19 (9):759 - 68。

PubMed ID

16142991 (在PubMed

]

文摘

癫痫持续状态患者迅速持续或反复发作。普遍抽搐的癫痫持续状态(GCSE)是最常见的疾病,是一种危及生命的疾病,需要提示医疗管理。癫痫持续状态,不应对一线苯二氮卓类(氯羟去甲安定或安定)或二线抗癫痫药物(苯妥英/ fosphenytoin,苯巴比妥或丙戊酸钠)通常被认为是耐火材料,需要更积极的治疗。耐火材料的最佳治疗GCSE没有定义,但患者应该在重症监护室治疗,如人工通气和血液动力学的支持是必需的。侵入性血流动力学监测通常是必要的和脑电图监测是至关重要的。耐火GCSE的药物治疗包括全身麻醉中给出连续静脉麻醉药剂量,废除所有临床和电记录的癫痫活动,常常需要镇静的爆发抑制脑电图。巴比妥酸盐麻醉药,戊巴比妥在美国和硫喷妥钠在欧洲和澳大利亚,是最常用的代理和高效耐火GCSE在儿童和成人。事实上,他们仍然停止发作活动的唯一方法与确定性严重难治性病例。其他选项为成人和儿童咪达唑仑和丙泊酚仅供成年人。无论选择了药物,静脉输液和升压通常需要治疗低血压。 Once seizures have been controlled for 12-24 hours, continuous intravenous therapy should be gradually tapered off if the drug being administered is midazolam or propofol. Gradual tapering is probably not necessary with pentobarbital or thiopental sodium. Continuous EEG monitoring is required during high-dose treatment and while therapy is gradually withdrawn. During withdrawal of anaesthetic therapy, intravenous phenytoin/fosphenytoin or valproate should be continued (these agents having been administered during earlier phases of GCSE) to ensure an adequate baseline of antiepileptic medication so as to prevent the recurrence of status epilepticus. If additional medication is needed, the most appropriate antiepileptic drugs are gabapentin for focal seizures and levetiracetam and topiramate for all seizure types, as these drugs can be started at high doses with a low risk of idiosyncratic reactions. Even with current best practice, mortality in patients who experience refractory GCSE is about 50% and only the minority return to their premorbid functional baseline. Therefore, new treatment options are urgently needed. The ideal new drug for refractory GCSE would be one that has the ability to stop seizures more effectively and safely than current drugs, and that has neuroprotective properties to prevent the brain damage and neurological morbidity caused by GCSE.

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药物

苯巴比妥