Osborne Andrew, Taylor Louise, Reuber Markus, Grünewald Richard A, Parkinson Martin, Dickson Jon M
Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom.
Academic Neurology Unit, The University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, South Yorkshire, United Kingdom.
Seizure. 2015 Jan;24:82-7. doi: 10.1016/j.seizure.2014.09.002. Epub 2014 Sep 16.
Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based.
Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies.
Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration.
The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.
癫痫发作是院前急救服务中常见的情况，会产生巨大的医疗费用。本文总结了英国救护车服务机构关于癫痫发作管理的指南，并探讨了这些指南基于证据的程度。
总结英国皇家联合学院救护车联络委员会关于癫痫发作管理的临床实践指南。回顾与癫痫发作紧急情况的院前管理相关的文献。
许多与癫痫患者院外紧急管理相关的标准做法源自通用的高级生命支持（ALS）指南，尽管许多患者在癫痫发作期间或之后不需要ALS，而且许多ALS干预措施对癫痫患者的益处仍有待确定。所确定的大多数研究都与癫痫持续状态的药物治疗有关。这些论文表明苯二氮䓬类药物安全有效，但无法就最佳药物或最佳给药途径得出明确结论。
当前癫痫发作紧急情况的院前指南的证据基础不完整。很大一部分患者在癫痫发作后被送往医院，但其中许多人可能适合在家中管理。然而，对于可用于帮助护理人员避免将患者送往医院的替代护理途径或标准的研究非常少。需要更多的研究来改善癫痫发作后患者的护理，并提高他们接受治疗的医疗系统的成本效益。
