Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Child Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Semin Neurol. 2020 Dec;40(6):661-674. doi: 10.1055/s-0040-1719076. Epub 2020 Nov 5.
Status epilepticus (SE) is one of the most common neurological emergencies in children and has a mortality of 2 to 4%. Admissions for SE are very resource-consuming, especially in refractory and super-refractory SE. An increasing understanding of the pathophysiology of SE leaves room for improving SE treatment protocols, including medication choice and timing. Selecting the most efficacious medications and giving them in a timely manner may improve outcomes. Benzodiazepines are commonly used as first line and they can be used in the prehospital setting, where most SE episodes begin. The diagnostic work-up should start simultaneously to initial treatment, or as soon as possible, to detect potentially treatable causes of SE. Although most etiologies are recognized after the first evaluation, the detection of more unusual causes may become challenging in selected cases. SE is a life-threatening medical emergency in which prompt and efficacious treatment may improve outcomes. We provide a summary of existing evidence to guide clinical decisions regarding the work-up and treatment of SE in pediatric patients.
癫痫持续状态（SE）是儿童中最常见的神经急症之一，死亡率为 2%至 4%。SE 的住院治疗非常耗费资源，尤其是在难治性和超难治性 SE 中。对 SE 病理生理学的认识不断提高，为改善 SE 治疗方案提供了空间，包括药物选择和时机。选择最有效的药物并及时给予药物可能会改善预后。苯二氮䓬类药物通常作为一线药物使用，可在 SE 发作的大多数起始场所——院前环境中使用。诊断性检查应与初始治疗同时进行，或尽快进行，以发现 SE 的潜在可治疗病因。尽管大多数病因在首次评估后即可识别，但在某些情况下，更罕见病因的检测可能具有挑战性。SE 是一种危及生命的医疗急症，及时有效的治疗可能会改善预后。我们提供了现有证据的总结，以指导关于儿科患者 SE 的检查和治疗的临床决策。
