Drislane F W
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Clin Neurophysiol. 1999 Jul;16(4):323-31; discussion 353. doi: 10.1097/00004691-199907000-00004.
Nonconvulsive status epilepticus (NCSE) is much more common than is generally appreciated and is certainly underdiagnosed, but its long-term effects are largely undetermined and remain controversial. There is increasing experimental evidence that generalized convulsive status epilepticus produces lasting neuropathologic damage in the hippocampus, but experimental models often include provocation of status epilepticus (SE) by physical (e.g., electrical stimulation) and chemical (including excitotoxic) agents that may induce damage independent of the epileptiform discharges. Also, damage appears to be related to the intensity and duration of electrical stimulation. Such models usually include high-frequency discharges sustained over long periods, somewhat different from the electrical activity of typical human NCSE. Pathologic studies in humans pertain primarily to patients who have had generalized convulsive status epilepticus. Clinical studies of the effects of NCSE are mandatory, but conclusions are difficult to come by, in part because of diverse definitions of NCSE. An altered mental status is obligatory, but the pertinent EEG and medication response criteria are controversial. Response to medication can be delayed by many hours or even days. Absence SE appears to cause no lasting effects. Complex partial SE is less uniform. Most reported cases have returned to baseline neurologic function, but several well-described patients have had prolonged memory deficits. The significance of other deficits is difficult to interpret in light of concomitant vascular and other diseases causing neurologic dysfunction. Clinical series usually lack premorbid neurologic and neuropsychologic assessment. The few exceptions are complicated by preexisting mental retardation and other deficits, by the coexistence of progressive illness, by the later effects of recurrent seizures, and almost always by the confounding influence of anticonvulsant medications. Most morbidity appears attributable to the underlying illnesses rather than to the NCSE itself. It is possible that relatively infrequent cases of prolonged NCSE or those with the synergistic effect of concomitant systemic illness, focal lesions, or very rapid excitatory epileptiform discharges may suffer more long-lasting damage, but these observations are still preliminary. NCSE should be treated expeditiously because of the acute neurologic impairment of the patients, because of the attendant morbidity including physical injury, and because it may go on to generalized convulsions. There is reasonable concern about possible long-term effects, but permanent neurologic damage from NCSE has not yet been established as a mandate for urgent treatment.
非惊厥性癫痫持续状态（NCSE）比人们普遍认识到的更为常见，而且肯定存在诊断不足的情况，但其长期影响在很大程度上尚未确定，仍存在争议。越来越多的实验证据表明，全身性惊厥性癫痫持续状态会在海马体中产生持久的神经病理损伤，但实验模型通常包括通过物理（如电刺激）和化学（包括兴奋性毒性）药物诱发癫痫持续状态（SE），这些药物可能会独立于癫痫样放电而导致损伤。此外，损伤似乎与电刺激的强度和持续时间有关。此类模型通常包括长时间持续的高频放电，这与典型人类NCSE的电活动有所不同。人类的病理研究主要针对全身性惊厥性癫痫持续状态的患者。对NCSE影响的临床研究是必要的，但得出结论很困难，部分原因是NCSE的定义多种多样。意识状态改变是必然的，但相关的脑电图和药物反应标准存在争议。对药物的反应可能会延迟数小时甚至数天。失神性SE似乎不会造成持久影响。复杂部分性SE则不太一致。大多数报道的病例已恢复到基线神经功能，但有几位详细描述的患者出现了长期记忆缺陷。鉴于同时存在的血管疾病和其他导致神经功能障碍的疾病，其他缺陷的意义难以解释。临床系列研究通常缺乏病前神经和神经心理评估。少数例外情况因存在先天性智力障碍和其他缺陷、进行性疾病的共存、反复发作的后期影响，以及几乎总是因抗惊厥药物的混杂影响而变得复杂。大多数发病率似乎归因于基础疾病而非NCSE本身。相对罕见的长时间NCSE病例，或那些伴有全身性疾病、局灶性病变协同作用或非常快速的兴奋性癫痫样放电的病例，可能会遭受更持久的损伤，但这些观察结果仍属初步。由于患者存在急性神经损伤，由于伴随的发病率包括身体损伤，以及因为它可能会发展为全身性惊厥，所以应迅速治疗NCSE。对于可能的长期影响存在合理担忧，但NCSE导致的永久性神经损伤尚未被确立为紧急治疗的必要依据。
