Nagayama Masao, Yang Sunghoon
Department of Neurology and Center for Stroke and Neurocritical Care, International University of Health and Welfare Atami Hospital.
Brain Nerve. 2015 May;67(5):553-62. doi: 10.11477/mf.1416200180.
Mainly after 2000, we have reported novel manifestations of nonconvulsive status epilepticus (NCSE), such as reversible protracted coma, posthyperventilation apnea, and higher brain dysfunctions, including Klüver-Bucy syndrome. In this review, we discuss the progress in clinical practice and research of NCSE with best available evidence, especially the spectrum of electroencephalographic abnormalities in NCSE, clinical manifestations of malignant NCSE, relationship between sudden unexpected death in epilepsy (SUDEP) and NCSE, and a strategy for real-time neuromonitoring. In addition, we propose some new concepts, NCSE, such as the antiepileptic drug-responsive neurological deficit (ADND), critical NCSE, fosphenytoin challenge test, epilepsy-related organ dysfunction (Epi-ROD), and a Neurocritical Score (Integrated Scale) for the comprehensive and serial evaluation of neurocritical conditions. We emphasize the need for the neuromonitoring of NCSE of broader neurological and neurocritical manifestations not only in the intensive care unit but also in the emergency room, outpatient clinic, inpatient ward, and social settings.
主要在2000年之后，我们报道了非惊厥性癫痫持续状态（NCSE）的新表现，如可逆性迁延性昏迷、过度换气后呼吸暂停以及包括克吕弗-布西综合征在内的高级脑功能障碍。在本综述中，我们利用现有最佳证据讨论NCSE在临床实践和研究方面的进展，尤其是NCSE的脑电图异常谱、恶性NCSE的临床表现、癫痫性猝死（SUDEP）与NCSE之间的关系以及实时神经监测策略。此外，我们提出了一些关于NCSE的新概念，如抗癫痫药物反应性神经功能缺损（ADND）、重症NCSE、磷苯妥英激发试验、癫痫相关器官功能障碍（Epi-ROD）以及用于综合和连续评估神经重症状况的神经重症评分（综合量表）。我们强调不仅在重症监护病房，而且在急诊室、门诊、住院病房和社会环境中，都需要对具有更广泛神经和神经重症表现的NCSE进行神经监测。
