University of Kentucky, Lexington, KY, USA.
Neurocrit Care. 2012 Aug;17(1):24-30. doi: 10.1007/s12028-012-9711-3.
Numerous anticonvulsant agents are now available for treating status epilepticus (SE). However, a paucity of data is available to guide clinicians in the initial treatment of seizures or SE. This study describes the current strategies being employed to treat SE in the U.S.A.
Fifteen American academic medical centers completed a retrospective, multicenter, observational study by reviewing 10-20 of the most recent cases of SE at their institution prior to December 31, 2009. A multivariate analysis was performed to determine factors associated with cessation of seizures.
A total of 150 patients were included. Most patients with SE had a seizure disorder (58%). SE patients required a median of 3 AEDs for treatment. Three quarters of patients received a benzodiazepine as first-line therapy (74.7%). Phenytoin (33.3%) and levetiracetam (10%) were commonly used as the second AED. Continuous infusions of propofol, barbiturate, or benzodiazepine were used in 36% of patients. Median time to resolution of SE was 1 day and was positively associated with presence of a complex partial seizure, AED non-compliance prior to admission, and lorazepam plus another AED as initial therapy. Prolonged ICU length of stay and topiramate therapy prior to admission were negatively associated with SE resolution. Mortality was higher in patients without a history of seizure (22.2 vs. 6.9%, p = 0.006).
The use of a benzodiazepine followed by an AED, such as phenytoin or levetiracetam, is common as first and second-line therapy for SE and appears to be associated with a shorter time to SE resolution. AED selection thereafter is highly variable. Patients without a history of seizure who develop SE had a higher mortality rate.
目前有许多抗癫痫药物可用于治疗癫痫持续状态（SE）。然而，可用的数据很少，无法指导临床医生对癫痫或 SE 进行初始治疗。本研究描述了目前在美国用于治疗 SE 的策略。
15 家美国学术医疗中心通过回顾其机构在 2009 年 12 月 31 日之前的最近 10-20 例 SE 病例，完成了一项回顾性、多中心、观察性研究。进行了多变量分析以确定与癫痫发作停止相关的因素。
共纳入 150 例患者。大多数 SE 患者患有癫痫发作障碍（58%）。SE 患者需要中位数为 3 种 AED 进行治疗。四分之三的患者接受苯二氮䓬类药物作为一线治疗（74.7%）。苯妥英（33.3%）和左乙拉西坦（10%）通常作为第二种 AED 使用。丙泊酚、巴比妥类或苯二氮䓬类药物的持续输注在 36%的患者中使用。SE 缓解的中位时间为 1 天，与复杂部分性癫痫发作、入院前 AED 不依从以及初始治疗时使用劳拉西泮加另一种 AED 呈正相关。入住 ICU 时间延长和入院前使用托吡酯与 SE 缓解呈负相关。无癫痫发作史的患者死亡率更高（22.2%比 6.9%，p = 0.006）。
在 SE 中，苯二氮䓬类药物联合 AED（如苯妥英或左乙拉西坦）的使用作为一线和二线治疗非常常见，并且似乎与 SE 缓解时间更短相关。此后 AED 的选择高度可变。无癫痫发作史的患者发生 SE 死亡率更高。
