N-甲基-D-天冬氨酸受体拮抗剂氯胺酮在难治性和超难治性癫痫持续状态中的早期应用
Early Use of the NMDA Receptor Antagonist Ketamine in Refractory and Superrefractory Status Epilepticus.
作者信息
Zeiler F A
机构信息
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada R3A 1R9.
出版信息
Crit Care Res Pract. 2015;2015:831260. doi: 10.1155/2015/831260. Epub 2015 Jan 12.
Refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE) pose a difficult clinical challenge. Multiple cerebral receptor and transporter changes occur with prolonged status epilepticus leading to pharmacoresistance patterns unfavorable for conventional antiepileptics. In particular, n-methyl-d-aspartate (NMDA) receptor upregulation leads to glutamate mediated excitotoxicity. Targeting these NMDA receptors may provide a novel approach to otherwise refractory seizures. Ketamine has been utilized in RSE. Recent systematic review indicates 56.5% and 63.5% cessation in seizures in adults and pediatrics, respectively. No complications were described. We should consider earlier implementation of ketamine or other NMDA receptor antagonists, for RSE. Prospective study of early implementation of ketamine should shed light on the role of such medications in RSE.
难治性癫痫持续状态（RSE）和超难治性癫痫持续状态（SRSE）构成了一项艰巨的临床挑战。随着癫痫持续状态的延长，会出现多种脑受体和转运体变化，导致产生不利于传统抗癫痫药物的耐药模式。特别是，N-甲基-D-天冬氨酸（NMDA）受体上调会导致谷氨酸介导的兴奋性毒性。针对这些NMDA受体可能为治疗原本难治的癫痫发作提供一种新方法。氯胺酮已被用于治疗RSE。最近的系统评价表明，成人和儿童癫痫发作停止的比例分别为56.5%和63.5%。未描述有并发症。对于RSE，我们应考虑更早地使用氯胺酮或其他NMDA受体拮抗剂。氯胺酮早期应用的前瞻性研究应能阐明此类药物在RSE中的作用。
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