Santillanes Genevieve, Luc Quyen
Pediatr Emerg Med Pract. 2015 Mar;12(3):1-25; quiz 26-7.
Seizures account for 1% of all emergency department visits for children, and the etiologies range from benign to life-threatening. The challenge for emergency clinicians is to diagnose and treat the life-threatening causes of seizures while avoiding unnecessary radiation exposure and painful procedures in patients who are unlikely to have an emergent pathology. When treating patients in status epilepticus, emergency clinicians are also faced with the challenge of choosing anticonvulsant medications that will be efficacious while minimizing harmful side effects. Unfortunately, evidence to guide the evaluation and management of children presenting with new and breakthrough seizures and status epilepticus is limited. This review summarizes available evidence and guidelines on the diagnostic evaluation of first-time, breakthrough, and simple and complex febrile seizures. Management of seizures in neonates and seizures due to toxic ingestions is also reviewed.
癫痫发作占儿童急诊就诊病例的1%，其病因从良性到危及生命不等。急诊临床医生面临的挑战是诊断和治疗危及生命的癫痫发作原因，同时避免对不太可能患有紧急病变的患者进行不必要的辐射暴露和痛苦的检查。在治疗癫痫持续状态的患者时，急诊临床医生还面临着选择有效抗惊厥药物同时尽量减少有害副作用的挑战。不幸的是，指导评估和管理新发、突破性癫痫发作以及癫痫持续状态患儿的证据有限。本综述总结了关于首次发作、突破性发作以及单纯性和复杂性热性惊厥诊断评估的现有证据和指南。还对新生儿癫痫发作及中毒性摄入所致癫痫发作的管理进行了综述。
