Department of Pharmacy, Neurosciences Intensive Care Unit, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
Department of Pharmacy Practice (MC 886), College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
Semin Neurol. 2020 Dec;40(6):681-695. doi: 10.1055/s-0040-1718721. Epub 2020 Nov 11.
Status epilepticus is a neurological emergency with an outcome that is highly associated with the initial pharmacotherapy management that must be administered in a timely fashion. Beyond first-line therapy of status epilepticus, treatment is not guided by robust evidence. Optimal pharmacotherapy selection for individual patients is essential in the management of seizures and status epilepticus with careful evaluation of pharmacokinetic and pharmacodynamic factors. With the addition of newer antiseizure agents to the market, understanding their role in the management of status epilepticus is critical. Etiology-guided therapy should be considered in certain patients with drug-induced seizures, alcohol withdrawal, or autoimmune encephalitis. Some patient populations warrant special consideration, such as pediatric, pregnant, elderly, and the critically ill. Seizure prophylaxis is indicated in select patients with acute neurological injury and should be limited to the acute postinjury period.
癫痫持续状态是一种神经急症，其结局与初始的药物治疗管理密切相关，必须及时进行。除了癫痫持续状态的一线治疗外，治疗并没有可靠的证据指导。对于个体患者，最佳的药物治疗选择对于癫痫和癫痫持续状态的管理至关重要，需要仔细评估药代动力学和药效动力学因素。随着新型抗癫痫药物的上市，了解它们在癫痫持续状态管理中的作用至关重要。对于药物诱导的癫痫发作、酒精戒断或自身免疫性脑炎的某些患者，应考虑病因导向治疗。某些患者群体需要特别考虑，如儿科、妊娠、老年和危重症患者。对于急性神经损伤的某些选择性患者，需要进行癫痫预防，且应仅限于急性损伤后时期。
