Kuchta J, Klug N, Ernestus R-I
iWIZ spine center, Department of Neurosurgery, interdisziplin ä res Wirbels ä ulenzentrum Bonn, Bonn, Germany.
Cent Eur Neurosurg. 2009 Nov;70(4):176-9. doi: 10.1055/s-0029-1224168. Epub 2009 Oct 22.
Nonconvulsive status epilepticus (NCSE) can occur in comatose patients without clinical signs of seizure activity. We evaluated the occurrence of NCSE in patients who were admitted to our neurosurgical intensive care unit between 1998 and 2000. EEGs were obtained from 158 patients with head trauma, spontaneous bleeding or brain tumour. Patients with clinically apparent seizure activity or no electrophysiological signs of seizure activity were excluded from the study. Epileptiform activity was seen in 28 out of 158 patients. 11/28 of these patients had a Glasgow-Coma-Scale (GCS) Score below 9 and showed continuous epileptiform discharge without clinical signs of seizure activity (NCSE). The clinical status of 4 of these 11 NCSE patients improved after initiation of anticonvulsive medication. NCSE may be an under-recognised cause of coma in neurosurgical intensive medicine. EEG should be included in the routine evaluation of comatose patients, even if clinical seizure activity is not apparent.
非惊厥性癫痫持续状态（NCSE）可发生于无癫痫发作临床体征的昏迷患者中。我们评估了1998年至2000年间入住我院神经外科重症监护病房的患者中NCSE的发生率。对158例头部外伤、自发性出血或脑肿瘤患者进行了脑电图检查。临床有明显癫痫发作活动或无癫痫发作电生理体征的患者被排除在研究之外。158例患者中有28例出现癫痫样活动。其中11/28的患者格拉斯哥昏迷量表（GCS）评分低于9分，且显示持续癫痫样放电但无癫痫发作的临床体征（NCSE）。这11例NCSE患者中有4例在开始抗惊厥药物治疗后临床状况有所改善。NCSE可能是神经外科重症医学中未被充分认识的昏迷原因。即使临床癫痫发作活动不明显，脑电图也应纳入昏迷患者的常规评估中。
