癫痫监测单元中的药物戒断——帕萨洛斯表。

Drug withdrawal in the epilepsy monitoring unit - The patsalos table.

机构信息

Department of Neurology Institute of Neurosciences, QEUH, Glasgow G51 4TF, United Kingdom.

Department of Clinical Neurophysiology, Institute of Neurosciences, QEUH, Glasgow G51 4TF, United Kingdom.

出版信息

Seizure. 2020 Feb;75:75-81. doi: 10.1016/j.seizure.2019.12.010. Epub 2019 Dec 28.

Abstract

Investigation of possible candidates for epilepsy surgery will usually require inpatient EEG to capture seizures and allow full operative planning. Withdrawal of antiepileptic drugs increases the yield of this valuable diagnostic information and the benefits of this should justify any increase in the risk of harm associated with these seizures This paper outlines our opinion on what would constitute proposed best practice for management of antiepileptic drug (AED) dosing when patients are admitted for monitoring of seizures to an epilepsy monitoring unit (EMU). In the vast majority of cases EMU admissions are safe and, even if seizures occur, will pass off without complication. Previous guidance has concentrated on ensuring practice around technical aspects of EEG monitoring itself and staffing within the unit. In this guidance we aim to outline optimally safe ways of ensuring that EMUs ensure the minimisation of risk to the patients admitted under their care. We propose an algorithm for enhancing the safety of AED withdrawal in VT admissions while ensuring adequate seizure yields. Risk minimisation requires planned management of drug dosing (with reduction if appropriate), provision of adequate rescue medication, and adequate supervision to allow rapid response to generalised seizures. This algorithm is accompanied by a table which uses knowledge of the clinical and pharmacological properties of each AED to ensure dose withdrawal and reduction is timely and safe taking into account the severity and frequency of the individual's seizures.

摘要

癫痫手术的潜在候选人的评估通常需要住院脑电图(EEG)来捕捉发作并进行全面手术规划。停用抗癫痫药物(AED)可以增加这种有价值的诊断信息的产出,而这种做法的好处应该足以证明与这些发作相关的任何风险增加都是合理的。本文概述了我们对癫痫监测单元(EMU)中癫痫发作监测患者的 AED 剂量管理提出的最佳实践建议。在绝大多数情况下,EMU 入院是安全的,即使发生癫痫发作,也不会有并发症。之前的指南主要集中在确保 EEG 监测本身的技术方面和单位内人员配置方面的实践。在本指南中,我们旨在概述确保 EMU 确保在其监护下入院的患者风险最小化的最佳安全方法。我们提出了一种算法,用于在确保足够发作量的同时增强 VT 入院时 AED 停药的安全性。风险最小化需要对药物剂量进行计划管理(如果需要则减少)、提供足够的抢救药物,并进行充分的监督,以便对全身性癫痫发作做出快速反应。该算法附有一个表格,该表格利用每种 AED 的临床和药理学特性知识,确保在考虑到个体癫痫发作的严重程度和频率的情况下,及时且安全地进行剂量停用和减少。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索