Division of Neurocritical Care and Comprehensive Epilepsy Center, Department of Neurology, Columbia University, Milstein Hospital Building, 177 Fort Washington Avenue, Milstein 8 Center, New York, NY 10032, USA.
Neurocrit Care. 2009 Dec;11(3):437-44. doi: 10.1007/s12028-009-9295-8.
Refractory status epilepticus (RSE) is associated with a high risk of poor outcome and treated by most neurointensivists with continuous intravenous antiepileptic medications (cIV-AEDs). Continuous EEG monitoring has allowed us to unveil a number of epileptiform patterns of less certain significance. These have been labeled ictal to interictal continuum (IIC), many of which are associated with poor outcome. It is unclear to which extent individual patterns are epiphenomena or lead to additional brain injury. The treatment of these patterns is highly controversial and guidelines how to manage them are non existent. In this review of a challenging case, I will discuss a number of approaches to determine the ictal nature of the IIC in an effort to minimize neuronal injury from epileptiform brain activity on the one hand and from the treatment on the other hand. Ultimately it will be most important to replace the dichotomy of ictal versus non-ictal patterns by differentiating between harmful and non-harmful patterns.
难治性癫痫持续状态（RSE）与预后不良的风险较高相关，大多数神经重症医生采用持续静脉内抗癫痫药物（cIV-AEDs）进行治疗。连续脑电图监测使我们能够揭示出许多具有较低确定性意义的癫痫样模式。这些被标记为发作间连续体（IIC），其中许多与预后不良有关。目前尚不清楚个体模式是偶然现象还是导致额外脑损伤的原因。这些模式的治疗极具争议性，目前尚无相关管理指南。在对这一具有挑战性的病例进行回顾时，我将讨论确定 IIC 发作性质的多种方法，一方面是为了尽量减少癫痫样脑活动引起的神经元损伤，另一方面是为了尽量减少治疗引起的损伤。最终，通过区分有害和无害模式，用发作与非发作模式之间的二分法来替代是最重要的。
