Department of Neurology, University Hospital (CHUV) and Faculty of Biology and Medicine, Lausanne, Switzerland.
Curr Opin Crit Care. 2010 Apr;16(2):105-9. doi: 10.1097/MCC.0b013e3283374b5b.
To review recent clinical data and summarize actual recommendations for the management of electrographic seizures and status epilepticus in neuro-ICU patients.
Electrographic, 'nonconvulsive', seizures are frequent in neuro-ICU patients including traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage and hypoxic-ischemic encephalopathy. Continuous electroencephalography monitoring is thus of great potential utility. The impact of electrographic seizures on outcome however is not entirely established and it is also unclear what type of electroencephalography paroxysms require treatment and when and how exactly to treat them. Evidence from randomized studies is lacking and will not be available in the near future. Given robust animal and human evidence showing the potential negative impact of seizures on secondary cerebral damage and outcome, treatment of seizures appears reasonable, particularly if related to status epilepticus. On the contrary, over-aggressive antiepileptic therapy entails risks. The management of seizures should therefore be guided individually, based on the underlying cause, the severity of illness and patient comorbidities.
We provide a pragmatic approach for the management of electrographic seizures in neuro-ICU patients. International consensus guidelines on continuous electroencephalography monitoring and seizure therapy are needed and would represent the rationale for a future multicenter randomized trial.
回顾神经重症监护病房（neuro-ICU）患者电发作和癫痫持续状态管理的最新临床数据，并总结实际推荐意见。
电发作，即“非惊厥性”发作，在包括创伤性脑损伤、蛛网膜下腔出血、脑出血和缺氧缺血性脑病在内的神经重症监护病房患者中较为常见。因此，连续脑电图监测具有很大的潜在应用价值。然而，电发作对结局的影响并不完全确定，也不清楚哪种类型的脑电图发作需要治疗，以及何时以及如何确切地进行治疗。缺乏随机研究证据，在不久的将来也不会有。鉴于强有力的动物和人类证据表明发作对继发性脑损伤和结局有潜在的负面影响，治疗发作似乎是合理的，特别是如果与癫痫持续状态有关。相反，过度积极的抗癫痫治疗会带来风险。因此，应根据潜在病因、疾病严重程度和患者合并症，个体化指导对电发作的管理。
我们为神经重症监护病房患者的电发作管理提供了一种实用的方法。需要制定关于连续脑电图监测和癫痫治疗的国际共识指南，这将为未来的多中心随机试验提供依据。
