Ann Emerg Med. 2014 Apr;63(4):437-47.e15. doi: 10.1016/j.annemergmed.2014.01.018.
This clinical policy from the American College of Emergency Physicians is the revision of a 2004 policy on critical issues in the evaluation and management of adult patients with seizures in the emergency department. A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) In patients with a first generalized convulsive seizure who have returned to their baseline clinical status, should antiepileptic therapy be initiated in the emergency department to prevent additional seizures? (2) In patients with a first unprovoked seizure who have returned to their baseline clinical status in the emergency department, should the patient be admitted to the hospital to prevent adverse events? (3) In patients with a known seizure disorder in which resuming their antiepileptic medication in the emergency department is deemed appropriate, does the route of administration impact recurrence of seizures? (4) In emergency department patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of a benzodiazepine, which agent or agents should be administered next to terminate seizures? A literature search was performed, the evidence was graded, and recommendations were given based on the strength of the available data in the medical literature.
这是美国急诊医师学院的一项临床政策，是对 2004 年关于急诊科成人癫痫患者评估和管理中关键问题的政策的修订。一个写作小组委员会审查了文献，得出了基于证据的建议，以帮助临床医生回答以下关键问题：(1) 在首次全面性强直-阵挛发作且已恢复基线临床状态的患者中，是否应在急诊科开始抗癫痫治疗以预防进一步发作？(2) 在首次无诱因发作且在急诊科已恢复基线临床状态的患者中，是否应将患者收治入院以预防不良事件？(3) 在已知癫痫发作疾病患者中，在急诊科恢复使用抗癫痫药物被认为是合适的，那么给药途径是否会影响癫痫发作的复发？(4) 在急诊科出现全面性强直-阵挛性癫痫持续状态且尽管已给予苯二氮䓬类药物的最佳剂量但仍持续发作的患者中，下一步应给予哪种或哪些药物来终止发作？进行了文献检索，对证据进行了分级，并根据医学文献中现有数据的强度给出了建议。
