Holtkamp Martin
Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Clin Neurophysiol. 2016 Feb;33(1):22-4. doi: 10.1097/WNP.0000000000000218.
Status epilepticus (SE) is a frequent neurologic emergency, one third of patients do not respond to treatment with benzodiazepines followed by a second antiepileptic drug. While initial treatment of complex partial SE is accordant to that of generalized convulsive SE, further management of refractory SE depends on the risk for acute complications and long-term clinical consequences. These risks are low in complex partial SE; therefore, in this clinical form anesthetics commonly are not used. Generalized convulsive SE-even in its early course-is a potentially life-threatening condition; therefore, prompt use of anesthetics is urgently required. Drugs of choice are barbiturates, midazolam, and propofol, all of which exhibit specific advantages and disadvantages. Up to now, data from clinical studies do not allow to prefer or to discard one of these anesthetics, therefore also barbiturates still should be used in refractory SE. A widely accepted in-house protocol for the management of initial and refractory SE is highly recommended.
癫痫持续状态（SE）是一种常见的神经系统急症，三分之一的患者对苯二氮䓬类药物治疗以及随后的第二种抗癫痫药物治疗无反应。虽然复杂部分性SE的初始治疗与全身性惊厥性SE的治疗一致，但难治性SE的进一步管理取决于急性并发症风险和长期临床后果。这些风险在复杂部分性SE中较低；因此，在这种临床类型中通常不使用麻醉剂。全身性惊厥性SE——即使在其早期阶段——也是一种潜在的危及生命的疾病；因此，迫切需要及时使用麻醉剂。首选药物是巴比妥类药物、咪达唑仑和丙泊酚，所有这些药物都有其特定的优缺点。到目前为止，临床研究数据无法确定哪种麻醉剂更优或应摒弃哪种麻醉剂，因此巴比妥类药物仍应用于难治性SE。强烈推荐采用一种广泛接受的院内初始和难治性SE管理方案。
