Watanabe Seiji, Okumura Yoshinori, Aiba Hideo
Department of Pediatrics, Shizuoka Children's, Hospital.
No To Hattatsu. 2014 Nov;46(6):443-6.
We experienced a case of acute encephalitis with refractory, repetitive partial seizures (AERRPS) found in an 8-year-old boy. Convulsive status epilepticus developed at the onset, which was intractable to the treatment with intravenous thiopental sodium even at the maximum dose of 9 mg/kg/hr. Since the adverse effect developed, thiopental sodium was discontinued. Phenobarbital (PB) was administrated at a very high daily dose up to 80 mg/kg, reaching serum trough level of 250 μg/ml, which was markedly effective to the treatment. Because seizures reappeared during tapering the dosage of PB, potassium bromide (KBr) at a daily dose of 80 mg/kg was additionally administrated. PB was successfully tapered into a daily dose of 20 mg/kg with a trough serum level around 80 μg/ml. He recovered in motor functions, but had disturbance of memory and apneic seizures. A very-high-dose PB therapy in an early period may be helpful for the treatment of intractable convulsive status epilepticus.
我们遇到了一例急性脑炎伴难治性反复部分性癫痫发作（AERRPS）的病例，患者为一名8岁男孩。发病时出现惊厥性癫痫持续状态，即使静脉注射硫喷妥钠至最大剂量9mg/kg/小时，治疗仍难以控制。由于出现不良反应，停用了硫喷妥钠。给予苯巴比妥（PB）极高的每日剂量，高达80mg/kg，血清谷浓度达到250μg/ml，治疗效果显著。因为在逐渐减少PB剂量期间癫痫发作再次出现，额外给予每日剂量80mg/kg的溴化钾（KBr）。PB成功减至每日剂量20mg/kg，血清谷浓度约为80μg/ml。他的运动功能恢复，但存在记忆障碍和呼吸暂停性癫痫发作。早期给予极高剂量的PB治疗可能有助于治疗难治性惊厥性癫痫持续状态。
