Corry Jesse J, Dhar Rajat, Murphy Theresa, Diringer Michael N
Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
Neurocrit Care. 2008;9(2):189-97. doi: 10.1007/s12028-008-9092-9.
Status epilepticus (SE) can be refractory to conventional anticonvulsants, requiring anesthetic doses of medications to suppress seizures. This approach carries significant morbidity, is associated with a high fatality rate, and may not always control SE. Hypothermia has been shown to suppress epileptiform activity experimentally, but has not previously been used as a primary modality to control SE in humans.
Four patients with SE refractory to benzodiazepine and/or barbiturate infusions were treated with hypothermia (target temperature: 31-35 degrees C) using an endovascular cooling system. All received continuous EEG monitoring, three were on midazolam infusions and one had recurrent seizures on weaning from pentobarbital.
Therapeutic hypothermia was successful in aborting seizure activity in all four patients, allowing midazolam infusions to be discontinued; three achieved a burst-suppression pattern on EEG. After controlled rewarming, two patients remained seizure-free, and all four demonstrated a marked reduction in seizure frequency. Adverse events included shivering, coagulopathy without bleeding, and venous thromboembolism. Two death occurred, neither directly related to hypothermia; however, immunosuppression related to the use of barbiturates and hypothermia may have contributed to an episode of fatal sepsis in one patient.
Hypothermia was able to suppress seizure activity in patients with SE refractory to traditional therapies with minimal morbidity. It appears promising as an alternative or an adjunct to anesthetic doses of other agents, but requires further study to better evaluate its safety and efficacy.
癫痫持续状态（SE）可能对传统抗惊厥药物难治，需要使用麻醉剂量的药物来抑制癫痫发作。这种方法具有显著的发病率，与高死亡率相关，并且可能并不总能控制癫痫持续状态。实验表明低温可抑制癫痫样活动，但此前尚未被用作控制人类癫痫持续状态的主要方法。
4例对苯二氮卓类和/或巴比妥类输注难治的癫痫持续状态患者使用血管内冷却系统进行低温治疗（目标温度：31 - 35摄氏度）。所有患者均接受持续脑电图监测，3例接受咪达唑仑输注，1例在停用戊巴比妥时出现反复癫痫发作。
治疗性低温成功终止了所有4例患者的癫痫发作活动，使咪达唑仑输注得以停用；3例脑电图呈现爆发抑制模式。在控制性复温后，2例患者无癫痫发作，所有4例患者癫痫发作频率均显著降低。不良事件包括寒战、无出血的凝血病和静脉血栓栓塞。发生2例死亡，均与低温无直接关系；然而，与使用巴比妥类药物和低温相关的免疫抑制可能导致1例患者发生致命性脓毒症。
低温能够以最小的发病率抑制对传统治疗难治的癫痫持续状态患者癫痫发作活动。作为其他药物麻醉剂量的替代或辅助方法，它似乎很有前景，但需要进一步研究以更好地评估其安全性和有效性。
