Misra Surendra, Singh N N
Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
J Indian Med Assoc. 2002 May;100(5):299-303.
Status epilepticus is a medical emergency, if not treated in time and effectively may cause significant mortality and morbidity. Medical therapy has been the mainstay of treatment but in refractory status surgical resection, multiple subpial transection, electroconvulsive therapy, caudate stimulation and acupuncture play important role. The present operational definition for adults and older children considers status as > or = 5 minutes of continuous seizure or two or more discrete seizures without regaining of full consciousness. Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy. Physiological changes in generalised convulsive status epilepticus include transient or early (0-30 minutes) and late (after 30 minutes) changes. Temporal changes occur as tonic-clonic status epilepticus progresses. Management can be considered in two ways--out hospital management and inpatient management. Benzodiazepine is considered 1st line of treatment outside hospital. Emergency/inpatient management includes basic life support (0-10 minutes) and pharmacological management (10-60 minutes). Drugs used in pharmacological management are lorazepam, midazolam, propofol, phenobarbital, phenytoin, fosphenytoin, i.v. valproate, rectal diazepam, etc. The classical definition of refractory status epilepticus includes seizure that has not responded to sequential treatment of lorazepam, phenytoin or phenobarbitone or seizure continuing > 60-90 in spite of adequate treatment.
癫痫持续状态是一种医疗急症，若不及时有效治疗可能导致显著的死亡率和发病率。药物治疗一直是主要的治疗方法，但对于难治性癫痫持续状态，手术切除、多处软膜下横切术、电惊厥治疗、尾状核刺激和针灸也发挥着重要作用。目前针对成人和大龄儿童的操作性定义认为，癫痫持续状态是指持续发作≥5分钟或两次或更多次离散发作且未完全恢复意识。癫痫持续状态占癫痫住院患者总数的1 - 8%。全身性惊厥性癫痫持续状态的生理变化包括短暂或早期（0 - 30分钟）及晚期（30分钟后）变化。随着强直 - 阵挛性癫痫持续状态的进展会出现时间上的变化。治疗可从两方面考虑——院外治疗和住院治疗。苯二氮䓬类药物被视为院外治疗的一线用药。急诊/住院治疗包括基本生命支持（0 - 10分钟）和药物治疗（10 - 60分钟）。药物治疗中使用的药物有劳拉西泮、咪达唑仑、丙泊酚、苯巴比妥、苯妥英、磷苯妥英、静脉注射丙戊酸盐、直肠用安定等。难治性癫痫持续状态的经典定义包括对劳拉西泮、苯妥英或苯巴比妥的序贯治疗无反应的发作，或尽管进行了充分治疗但发作仍持续>60 - 90分钟。
