Park Hea Ree, Song Pamela, Lee Jae Jung, Cho Joong-Yang
Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
J Epilepsy Res. 2018 Dec 31;8(2):93-96. doi: 10.14581/jer.18016. eCollection 2018 Dec.
Endosulfan is a highly toxic pesticide that causes hyperstimulation of the central nervous system by antagonizing gamma aminobutyric acid-mediated inhibition. Seizure is the most important manifestation of endosulfan poisoning, frequently progressing to status epilepticus and refractory status epilepticus. Here, we report a recent case of a 64-year-old man with endosulfan-induced super-refractory status epilepticus, which persisted for a remarkably longer period than has been described in previous reports. The patient arrived at the emergency room with continuous generalized tonic-clonic seizures. Electroencephalogram-recorded seizures that persisted even after intravenous administration of lorazepam and antiepileptic drugs. Intravenous anesthetic agents were administered for 9 days to confront the persistently recurring seizures. Immediately after this treatment period, the seizures subsided, and the patient showed marked neurological improvement. After 2 months however, he died of multiple systemic complications. This case report elucidates the importance of aggressive evaluation and management including continuous EEG monitoring in cases of endosulfan-related status epilepticus.
硫丹是一种剧毒农药，通过拮抗γ-氨基丁酸介导的抑制作用引起中枢神经系统的过度刺激。癫痫发作是硫丹中毒最重要的表现，常进展为癫痫持续状态和难治性癫痫持续状态。在此，我们报告一例近期的64岁男性患者，患有硫丹诱发的超难治性癫痫持续状态，其持续时间比以往报告中描述的要长得多。患者因持续性全身性强直阵挛发作被送至急诊室。脑电图记录显示，即使静脉注射劳拉西泮和抗癫痫药物后癫痫发作仍持续。静脉麻醉剂持续使用了9天以应对反复出现的癫痫发作。在这段治疗期后，癫痫发作立即停止，患者的神经功能有显著改善。然而，2个月后，他死于多种全身并发症。本病例报告阐明了在硫丹相关癫痫持续状态的病例中，包括持续脑电图监测在内的积极评估和管理的重要性。
