Child Neuropsychiatry Department, Epilepsy Center, C. Poma Hospital, Mantua, Italy.
Epilepsia. 2013 Oct;54 Suppl 7:23-34. doi: 10.1111/epi.12307.
The Italian League Against Epilepsy Commission Guidelines Subcommittee on Status Epilepticus (SE) has published an article on the management of SE in adults, and now presents a report on the management of convulsive status epilepticus (CSE) in children, excluding the neonatal period. Children's greater susceptibility than adults to epileptic seizures results from many factors. Earlier maturation of excitatory than inhibitory synapses, increased susceptibility and concentration of receptors for excitatory neurotransmitters, peculiar composition of the receptor subunits resulting in slower and less effective inhibitory responses, all cause the high incidence of SE in the pediatric population. The related morbidity and mortality rates, although lower than in adults, require immediate diagnosis and therapy. The division into focal and generalized, nonconvulsive and convulsive SE is applied in children and adolescents, as is the distinction in the three different stages according to the time elapsed since the start of the event and the response to drugs (initial, defined, and refractory SE). In children and adolescents, an "operational definition" is also accepted to allow earlier treatment (starting at 5-10 min). Maintenance and stabilization of vital functions, cessation of convulsions, diagnosis, and initial treatment of potentially "life-threatening" causes are the objectives to be pursued in the management of children with CSE. The need for early pharmacologic intervention stresses the need for action in the prehospital setting, generally using rectal diazepam. In hospital, parenteral benzodiazepines are used (lorazepam, diazepam, or midazolam). When first-line drugs fail, sodium phenytoin and phenobarbital should be used. As alternatives to phenobarbital, the following can be considered for treatment of refractory CSE: valproate, levetiracetam, and lacosamide. In cases with refractory CSE, pharmacologic options can be thiopental, midazolam, or propofol in continuous intravenous infusions to suppress electroencephalographic bursts and convulsive activity. These drugs need to be administered in intensive care units to ensure the monitoring and support of vital signs and brain electrical activity.
意大利癫痫联盟委员会指南癫痫持续状态（SE）小组委员会发表了一篇关于成人 SE 管理的文章，现在介绍了一篇关于儿童（不包括新生儿期）惊厥性癫痫持续状态（CSE）管理的报告。儿童比成人更容易发生癫痫发作，这是由多种因素引起的。兴奋性突触比抑制性突触更早成熟，兴奋性神经递质受体的敏感性和浓度增加，受体亚单位的特殊组成导致抑制性反应更慢且效果更差，所有这些因素导致儿科人群中 SE 的高发生率。尽管相关的发病率和死亡率低于成人，但仍需要立即诊断和治疗。在儿童和青少年中，应用了局灶性和全身性、非惊厥性和惊厥性 SE 的分类，以及根据事件开始后时间和药物反应（初始、明确和难治性 SE）分为三个不同阶段的区别。在儿童和青少年中，也接受了“操作性定义”以允许更早的治疗（开始于 5-10 分钟）。在 CSE 患儿的管理中，维持和稳定生命功能、停止惊厥、诊断和初始治疗潜在“危及生命”的病因是需要追求的目标。早期药物干预的必要性强调了在院前环境中采取行动的必要性，通常使用直肠地西泮。在医院中，使用静脉注射苯二氮䓬类药物（劳拉西泮、地西泮或咪达唑仑）。一线药物失败时，应使用苯妥英钠和苯巴比妥。作为苯巴比妥的替代药物，可以考虑以下药物治疗难治性 CSE：丙戊酸钠、左乙拉西坦和拉科酰胺。对于难治性 CSE 病例，可以选择硫喷妥钠、咪达唑仑或丙泊酚持续静脉输注以抑制脑电图爆发和惊厥活动。这些药物需要在重症监护病房中使用，以确保监测和支持生命体征和脑电活动。
