Drislane F W
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, KS-477, 330 Brookline Avenue, Boston, Massachusetts, 02115.
Epilepsy Behav. 2000 Oct;1(5):301-14. doi: 10.1006/ebeh.2000.0100.
Nonconvulsive status epilepticus (NCSE) is much more common than is generally appreciated. It is certainly underdiagnosed, but its presentation is protean. Diagnostic criteria and treatment are controversial. Absence status is characterized by confusion or diminished responsiveness, with occasional blinking or twitching, lasting hours to days, with generalized spike and slow wave discharges on the EEG. Complex partial status consists of prolonged or repetitive complex partial seizures (with a presumed focal onset) and produces an "epileptic twilight state" with fluctuating lack of responsiveness or confusion. There is a clear overlapping of syndromes. Other confused, stuporous, or comatose patients with rapid, rhythmic, epileptiform discharges on the EEG may have "electrographic" status and should be considered in the same diagnostic category. NCSE typically occurs following supposedly controlled convulsions or other seizures, but with persistent neurologic dysfunction despite apparently adequate treatment. Confusion in the elderly or among emergency room patients is also a typical setting. The diagnosis of NCSE usually involves an abnormal mental status with diminished responsiveness, a supportive EEG, and often a response to anticonvulsant medication. All patients have clinical neurologic deficits, but the EEG findings and response to seizure medication are variable and are more controversial criteria. The response to drugs can be delayed for up to days. Experimental models and pathologic studies showing neuronal damage from status epilepticus pertain primarily to generalized convulsive status. Most morbidity from NCSE appears due to the underlying illness rather than to the NCSE itself. Some cases of prolonged NCSE or those with concomitant systemic illness, focal lesions, or very rapid epileptiform discharges may suffer more long-lasting damage. Although clinical studies show little evidence of permanent neurologic injury, the prolonged memory dysfunction in several cases and the similarities to convulsive status suggest that NCSE should be treated expeditiously. The diagnosis is important to make because NCSE impairs the patient's health significantly, and it is often a treatable and completely reversible condition.
非惊厥性癫痫持续状态（NCSE）比人们普遍认为的更为常见。它肯定存在诊断不足的情况，但其表现形式多样。诊断标准和治疗方法存在争议。失神状态的特征是意识模糊或反应迟钝，偶尔伴有眨眼或抽搐，持续数小时至数天，脑电图显示为广泛性棘波和慢波放电。复杂部分性状态由长时间或重复性的复杂部分性发作（推测为局灶性起病）组成，并产生“癫痫朦胧状态”，伴有反应迟钝或意识模糊的波动。各综合征之间存在明显的重叠。其他脑电图显示有快速、节律性癫痫样放电的意识模糊、昏迷或昏睡患者可能患有“脑电图型”状态，应归入同一诊断类别。NCSE通常发生在据推测已得到控制的惊厥或其他发作之后，但尽管进行了看似充分的治疗，仍存在持续性神经功能障碍。老年人或急诊室患者出现意识模糊也是典型的情况。NCSE的诊断通常涉及精神状态异常、反应迟钝、支持性脑电图结果，且通常对抗惊厥药物有反应。所有患者都有临床神经功能缺损，但脑电图结果和对癫痫药物的反应各不相同，且是更具争议性的标准。对药物的反应可能会延迟数天。实验模型和病理研究表明，癫痫持续状态导致的神经元损伤主要与全身性惊厥性状态有关。NCSE导致的大多数发病率似乎归因于基础疾病，而非NCSE本身。一些长时间的NCSE病例或伴有全身性疾病、局灶性病变或非常快速的癫痫样放电的病例可能会遭受更持久的损害。尽管临床研究几乎没有证据表明存在永久性神经损伤，但几例病例中出现的长时间记忆功能障碍以及与惊厥性状态的相似之处表明，NCSE应迅速得到治疗。做出诊断很重要，因为NCSE会严重损害患者的健康，而且它通常是一种可治疗且完全可逆的病症。
