Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Brain. 2011 Oct;134(Pt 10):2802-18. doi: 10.1093/brain/awr215. Epub 2011 Sep 13.
Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 h or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anaesthesia. It is an uncommon but important clinical problem with high mortality and morbidity rates. This article reviews the treatment approaches. There are no controlled or randomized studies, and so therapy has to be based on clinical reports and opinion. The published world literature on the following treatments was critically evaluated: anaesthetic agents, anti-epileptic drugs, magnesium infusion, pyridoxine, steroids and immunotherapy, ketogenic diet, hypothermia, emergency resective neurosurgery and multiple subpial transection, transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation, electroconvulsive therapy, drainage of the cerebrospinal fluid and other older drug therapies. The importance of treating the identifying cause is stressed. A protocol and flowchart for managing super-refractory status epilepticus is suggested. In view of the small number of published reports, there is an urgent need for the establishment of a database of outcomes of individual therapies.
超难治性癫痫持续状态定义为麻醉治疗开始后 24 小时或更长时间持续或复发的癫痫持续状态，包括在麻醉减少或停止后癫痫持续状态复发的情况。这是一个罕见但重要的临床问题，具有高死亡率和发病率。本文回顾了治疗方法。由于没有对照或随机研究，因此治疗必须基于临床报告和意见。对以下治疗方法的已发表世界文献进行了批判性评估：麻醉剂、抗癫痫药物、镁输注、吡哆醇、类固醇和免疫疗法、生酮饮食、低温、紧急切除性神经外科手术和多发性软脑膜切开术、经颅磁刺激、迷走神经刺激、深部脑刺激、电惊厥疗法、脑脊髓液引流和其他较旧的药物治疗。强调了治疗确定病因的重要性。建议制定管理超难治性癫痫持续状态的方案和流程图。鉴于已发表报告的数量较少，迫切需要建立一个个体治疗结果的数据库。
