Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Curr Opin Crit Care. 2012 Apr;18(2):127-31. doi: 10.1097/MCC.0b013e32835132cc.
Refractory status epilepticus (RSE) has a high morbidity and mortality. There are currently no definitive data to guide both the optimal choice of therapy and treatment goals. This review focuses on RSE diagnosis and outcome and discusses both commonly used and anecdotal therapies for RSE.
The challenges in performing randomized controlled trials (RCTs) in neurocritical care and more specifically for the treatment of RSE are illustrated by the early termination of the first RCT of RSE due to low recruitment that compared propofol to barbiturates. Recent case series include the successful treatment of recurrent RSE with ketamine, intravenous lacosamide as an add-on treatment, the use of combination antiepileptics (phenytoin, levetiracetam, and pregabalin), and surgical treatments (vagal nerve and deep brain stimulation) for the control of RSE.
A number of different therapeutic options are available for the treatment of RSE but none have been shown to be superior to others at this point.
难治性癫痫持续状态（RSE）具有较高的发病率和死亡率。目前尚无明确的数据指导最佳的治疗选择和治疗目标。本综述重点讨论 RSE 的诊断和结局，并讨论 RSE 的常用和传闻疗法。
神经危重病学中进行随机对照试验（RCT）的挑战，更具体地说，RSE 的治疗由于首次 RCT 因招募人数低而提前终止，该 RCT 比较了丙泊酚与巴比妥类药物，说明了 RSE 的 RCT 面临的挑战。最近的病例系列包括氯胺酮成功治疗复发性 RSE、静脉用拉科酰胺作为附加治疗、联合抗癫痫药（苯妥英钠、左乙拉西坦和普瑞巴林）以及手术治疗（迷走神经和深部脑刺激）控制 RSE。
有许多不同的治疗选择可用于治疗 RSE，但目前尚无一种方法被证明优于其他方法。
