Lu Lu, Xiong Weixi, Zhang Yingying, Xiao Yingfeng, Zhou Dong
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2019 Jul;98(27):e16257. doi: 10.1097/MD.0000000000016257.
Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common forms of childhood epilepsy, which is expected to resolve before 16 years of age, with mild effects on the cognitive or behavioral functions in adulthood. This study aims to report the first propofol-induced refractory status epilepticus (SE) in patients with BECTS after 16 years of age, and to review SE in BECTS or induced by propofol.
A 16-year-old Chinese girl, who was diagnosed with BECTS at the age of 2 years, developed refractory SE induced by propofol administered during the maintenance stage of general anesthesia during a plastic surgery procedure.
Considering her medical history, EEG, and magnetic resonance images, and brain computed tomography, a diagnosis of refractory SE in BECTS was confirmed.
The patient had been seizure-free for 3 years from treatment with 2 anti-epileptic drugs (AEDs) valproate acid (VPA) and oxcarbazepine (OXC), and had started monotherapy with OXC for 3 months before the seizure incidence. She had undergone blepharoplasty under local anesthesia prior to receiving general anesthesia. During the maintenance state she developed convulsive SE, which was uncontrolled seizure and lasted for 14 hours. The treatment for which included midazolam, diazepam, propofol, VPA, OXC, and levetiracetam (LEV).
The prolonged seizure was controlled by diazepam (4 mg/h), propofol (6 mg/kg/h), VPA (2400 mg/d intravenous injection). Subsequently, she was administered VPA (800 mg/d po), OXC (600 mg/d po), and LEV (1000 mg/d po). Finally, on the 17th day she was discharged, and did not have any seizure recurrence and EEG results were normal as noted during the 3-month follow-up.
This was the first report of an SE in BECTS patient past the remission age. This report implied that interventions of sedation or analgesia in a patient after remission age of BECTS might still be at risk of refractory SE and therefore, should be carefully evaluated and monitored during such procedures, especially when an AED medication has been withdrawn or altered.
中央颞区棘波的良性癫痫（BECTS）是儿童癫痫最常见的形式之一，预计在16岁前缓解，对成年后的认知或行为功能影响较小。本研究旨在报告首例16岁后BECTS患者因丙泊酚诱发的难治性癫痫持续状态（SE），并回顾BECTS或丙泊酚诱发的SE。
一名16岁中国女孩，2岁时被诊断为BECTS，在一次整形手术的全身麻醉维持阶段，因使用丙泊酚而发生难治性SE。
结合其病史、脑电图、磁共振成像和脑部计算机断层扫描，确诊为BECTS中的难治性SE。
患者使用丙戊酸（VPA）和奥卡西平（OXC）两种抗癫痫药物（AEDs）治疗3年无癫痫发作，在癫痫发作前3个月开始使用OXC单药治疗。在接受全身麻醉前，她已在局部麻醉下进行了眼睑成形术。在维持状态下，她出现惊厥性SE，癫痫发作无法控制，持续了14小时。治疗包括咪达唑仑、地西泮、丙泊酚、VPA、OXC和左乙拉西坦（LEV）。
长时间的癫痫发作通过地西泮（4mg/h）、丙泊酚（6mg/kg/h）、VPA（2400mg/d静脉注射）得到控制。随后，给她服用VPA（800mg/d口服）、OXC（600mg/d口服）和LEV（1000mg/d口服）。最后，在第17天她出院了，在3个月的随访中未出现任何癫痫复发，脑电图结果正常。
这是BECTS患者超过缓解年龄后发生SE的首例报告。本报告表明，在BECTS缓解年龄后的患者中进行镇静或镇痛干预仍可能有发生难治性SE的风险，因此，在此类手术过程中应仔细评估和监测，尤其是在停用或更改AED药物时。
