Department of Pediatrics, AIIMS, Ansari Nagar, New Delhi, 110029, India.
Indian J Pediatr. 2011 Feb;78(2):219-26. doi: 10.1007/s12098-010-0291-y. Epub 2010 Dec 11.
Status epilepticus is a common neurological emergency in childhood and associated with significant morbidity and mortality. Status epilepticus (SE) has been defined as continuous seizure activity lasting more than 30 min or 2 or more seizures in this duration without gaining consciousness between them. However, the operational definition has brought the time down to 5 min. Management can be broadly divided into initial stabilization, seizure termination, and evaluation and treatment of the underlying cause. Diagnostic evaluation and seizure control should be achieved simultaneously to improve outcome. Seizure termination is achieved by pharmacotherapy. Benzodiazepines are the first line drugs for SE. Commonly used drugs include lorazepam, diazepam, and midazolam. In children without an IV access, buccal or nasal midazolam or rectal diazepam can be used. Phenytoin as a second line agent is usually indicated when seizure is not controlled after one or more doses of benzodiazepines. If the seizures continue to persist, valproate, phenobarbitone or levetiracetam is indicated. Midazolam infusion is useful in refractory status epilepticus. Thiopentone, propofol or high dose phenobarbitone are considered for treatment of refractory status epilepticus. Prolonged SE is associated with higher morbidity and mortality. Long term neurological sequelae include epilepsy, behavioural problems, cognitive decline, and focal neurologic deficits.
癫痫持续状态是儿童期常见的神经急症，与较高的发病率和死亡率相关。癫痫持续状态（SE）被定义为持续发作超过 30 分钟或在这段时间内发作 2 次或更多次，且发作之间没有意识恢复。然而，操作定义已经将时间缩短至 5 分钟。治疗可以大致分为初始稳定、终止发作以及评估和治疗潜在病因。应同时进行诊断评估和癫痫控制，以改善预后。通过药物治疗终止发作。苯二氮䓬类药物是 SE 的一线药物。常用药物包括劳拉西泮、地西泮和咪达唑仑。对于没有静脉通路的儿童，可以使用口腔或鼻腔咪达唑仑或直肠地西泮。如果在使用苯二氮䓬类药物 1 或 2 剂后仍未控制发作，通常会使用苯妥英钠作为二线药物。如果发作持续存在，则应使用丙戊酸钠、苯巴比妥或左乙拉西坦。咪达唑仑输注对难治性癫痫持续状态有效。硫喷妥钠、丙泊酚或大剂量苯巴比妥可用于治疗难治性癫痫持续状态。长时间的 SE 与更高的发病率和死亡率相关。长期的神经后遗症包括癫痫、行为问题、认知能力下降和局灶性神经功能缺损。
