氯胺酮可控制癫痫持续状态。
Ketamine controls prolonged status epilepticus.
作者信息
Borris D J, Bertram E H, Kapur J
机构信息
Department of Neurology, Box 800394, University of Virginia Health Sciences Center, Charlottesville, VA, USA.
出版信息
Epilepsy Res. 2000 Dec;42(2-3):117-22. doi: 10.1016/s0920-1211(00)00175-3.
New treatments are needed to control prolonged status epilepticus given the high failure rate of current therapies. In an animal model of status epilepticus based on electrical stimulation of the hippocampus, rats demonstrate at least 5 five-hours of seizure activity following stimulation. Phenobarbital (70 mg/kg) administered 15 min after stimulation effectively controlled seizures in 66% of animals (n=6). When phenobarbital (70 mg/kg) was administered 60 min after stimulation, seizures were controlled in 25% of animals (n=4). Ketamine (100 mg/kg) administered 15 min after stimulation did not control seizures in any animal (n=4). But when ketamine was administered one hour after stimulation it effectively controlled seizures in all animals (n=4). Increasing doses of ketamine were administered 60 min after stimulation to generate a dose-response curve. The ketamine dose response (fraction of seizure free rats) data were fit to a sigmoid curve to derive an ED(50) of 58 mg/kg. These findings suggest that prolonged status epilepticus becomes refractory to phenobarbital but can be effectively controlled by ketamine. For patients experiencing prolonged status epilepticus that is refractory to phenobarbital, ketamine may be an alternative to general anesthesia.
鉴于当前治疗方法的高失败率，需要新的治疗方法来控制持续性癫痫状态。在基于海马体电刺激的癫痫持续状态动物模型中，大鼠在刺激后表现出至少5小时的癫痫发作活动。刺激后15分钟给予苯巴比妥（70mg/kg）可有效控制66%的动物（n=6）的癫痫发作。当在刺激后60分钟给予苯巴比妥（70mg/kg）时，25%的动物（n=4）的癫痫发作得到控制。刺激后15分钟给予氯胺酮（100mg/kg）未能控制任何动物（n=4）的癫痫发作。但当在刺激后1小时给予氯胺酮时，它有效控制了所有动物（n=4）的癫痫发作。在刺激后60分钟给予递增剂量的氯胺酮以生成剂量反应曲线。氯胺酮剂量反应（无癫痫发作大鼠的比例）数据拟合为S形曲线，得出半数有效剂量（ED50）为58mg/kg。这些发现表明，持续性癫痫状态对苯巴比妥变得难治，但可被氯胺酮有效控制。对于对苯巴比妥难治的持续性癫痫状态患者，氯胺酮可能是全身麻醉的一种替代方法。
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