三个欧洲国家难治性全身性惊厥性和复杂性部分性癫痫持续状态的管理：癫痫学家和重症监护神经科医生的一项调查
The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists.
作者信息
Holtkamp M, Masuhr F, Harms L, Einhäupl K M, Meierkord H, Buchheim K
机构信息
Department of Neurology, University Hospital Charité, Humboldt University, Schumannstrasse 20/21, 10117 Berlin, Germany.
出版信息
J Neurol Neurosurg Psychiatry. 2003 Aug;74(8):1095-9. doi: 10.1136/jnnp.74.8.1095.
OBJECTIVE
To survey the current clinical treatment of refractory status epilepticus and to identify steps in its management which may need further investigation.
METHODS
Epileptologists and critical care neurologists were surveyed using a standardised postal questionnaire.
RESULTS
Sixty three of 91 participants (69%) returned the questionnaires. Two thirds of the respondents applied another non-anaesthetising anticonvulsant after failure of first line drugs. General anaesthesia for ongoing complex partial status epilepticus (CPSE) was part of the therapeutic regimen of 75% of the interviewees. A non-barbiturate as general anaesthetic of first choice was used by 42%. Up to 70% titrated the anaesthetic to achieve a burst suppression pattern in the electroencephalogram, indicating deep sedation, and 94% reduce anaesthesia within 48 hours.
CONCLUSIONS
The management of refractory status epilepticus is heterogeneous in many aspects, even among clinicians who are most familiar with this severe condition. Randomised trials are needed to compare the efficacy, side effects, optimal duration, and depth of general anaesthesia.
目的
调查难治性癫痫持续状态的当前临床治疗情况，并确定其管理中可能需要进一步研究的步骤。
方法
使用标准化邮政问卷对癫痫学家和重症监护神经科医生进行调查。
结果
91名参与者中有63名（69%）回复了问卷。三分之二的受访者在一线药物治疗失败后应用了另一种非麻醉性抗惊厥药物。75%的受访者将持续复杂性部分性癫痫持续状态（CPSE）的全身麻醉作为治疗方案的一部分。42%的人使用非巴比妥类药物作为首选全身麻醉剂。高达70%的人滴定麻醉剂以在脑电图中实现爆发抑制模式，表明深度镇静，94%的人在48小时内减少麻醉。
结论
即使在最熟悉这种严重疾病的临床医生中，难治性癫痫持续状态的管理在许多方面也存在异质性。需要进行随机试验来比较全身麻醉的疗效、副作用、最佳持续时间和深度。
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